10-1-2021 Covid-19 Update

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ctober 1, 2021

Hello all,

I know you are tired of hearing from me, however we always like to keep you very well informed.  We had a staff member test positive today who had a PCR done on 9/28.  This individual has not been in our building since last Wednesday, 9/22. I am still obligated to let you know though. Have a great weekend and stay safe.

Julia McGlaughlin, RN/BSN

Executive Director of Clinical Services

Fahrney Keedy

301-671-5025

 

October 1, 2021

Dear Resident/Family/Resident Representative,

As required by Governor Hogan and the Maryland Department of Health (MDOH), our Facility is required to update you weekly on all of the mitigation procedures we are implementing and following to protect you or your loved one from COVID-19.  Please see the attached mitigation procedures the facility is currently observing to protect our valuable residents and staff.

Current Updates: 

Currently, we are again on Outbreak Status for Skilled Nursing ONLY.  We have had 1 staff member test positive and 3 residents test positive for COVID 19.  As of 9/30, we opened up more beds on the COVID unit in preparation for more cases.  We hope we do not have to utilize those beds, but we are prepared in case.  We are not accepting new admissions at this time until we are sure we have this under control. 

 

As of this morning, we have 18 pending staff swabs and 1 pending resident swabs.  We hope to have those results by close of business today. 

We will again test staff and residents next week and the week after. 

Resident Visitation:

At this time, there is no in-person resident visitation in the Skilled Nursing section of Fahrney Keedy except for Compassionate Visitation.  All residents may have electronic/social media visitation or window visits.  Any resident in Isolation Precautions may only have electronic/social media visitation.  

Assisted Living may have in-person visitation per facility policy as they are not part of the Outbreak. 

Vaccine Update:

We continue to offer COVID vaccines to our residents and staff.  Our current rate of resident vaccination is 93.4% in the Skilled Nursing Center.  Our current rate of resident vaccination is 98% in the Assisted Living Centers.  Our current rate of staff vaccination is 98.5%.  This information is reported weekly by the facility to Maryland Department of Health via Chesapeake Registry Information Systems (CRISP) and to the CDC through reports to the National Healthcare Safety Network (NHSN).  Here is the website to view this information for all nursing homes in Maryland:  https://aging.maryland.gov/Pages/SNFVD.aspx . 

Our County Positivity Rate is currently 8.4%.  Frederick County is 7.3%.  Allegany County is 17.4%.  Garrett County is 16.1%. Franklin Co, Pa is 15.6%.  Fulton Co, Pa is 11.3%.  Berkeley County, WV is 11.9%.  Jefferson County, WV is 12.2%.  Morgan County, WV is 17.2%. 

Washington County is the only county in Maryland, at this time, that has High levels of Community Transmission of COVID. 

Residents are not required to be vaccinated to reside in our facility.

Boosters

We have scheduled a COVID Booster Vaccine Clinic with Meritus Medical Center.  A group of nurses in their Community Outreach department will come to the facility on October 19, 20 and 21st.  These will be for those who have received Pfizer.  We are in the process of contacting residents and/or their resident representatives to obtain consents for administration.  We will administer to Skilled Nursing, Assisted Living and Independent Living Residents. 

 Testing:

At this time, we follow CMS guidance for staff testing.  Due to the high transmission rates of COVID in our community, we must test staff, who are not fully vaccinated, twice weekly.  We have approximately 17 staff members who are:  1) pregnant and waiting until after the birth of their child to receive vaccine, or 2) received the 1st dose of vaccine and pending their 2nd or 3) received their 2nd dose and must wait 14 days until they are considered fully vaccinated.  We also test any staff member, regardless of vaccine status, if they are presenting with symptoms. 

We test any staff member or resident who is presenting with symptoms of COVID 19. 

We are currently doing PCR testing weekly on staff and residents and will do so until we have 14 consecutive days of negative tests. 

 Positive Cases:

For the week of 9/27/21, we have had 1 staff member positive and 3 resident positives for COVID 19.

Influenza Vaccinations 2021/2022:

We appreciate all those who have returned their Influenza Vaccine consents.  We will be administering Fluzone High Dose to our residents as recommended by the CDC for anyone over the age of 65.  Pharmacare, our pharmacy, is having difficulty obtaining Fluzone High Dose from their supplier and the manufacturer.  They are expecting delivery of their order at the end of October, beginning of November.  At this time, we received a very small quantity of flu vaccines.  We are prioritizing those doses to residents who will be receiving a booster COVID vaccine the 3rd week of October.  We are doing this to space out their vaccines as 14 days are required between doses of any vaccine. 

Respectfully,

Angie Keebaugh LPN/QCP/IP

Director of Quality Assurance and Infection Control                                   

Infection Preventionist                                                                                      

301-671-5026

 

Marcia Frizzell LPN/IP

Quality Care Coordinator

Infection Preventionist

301-671-5013 

Below, you will find a list of all the mitigation (preventive) measures the Facility has taken as of today.  If you have questions, please do not hesitate to contact the Facility.

Fahrney-Keedy

Visitation Policy

Updated 10-01-2021

For visitation, here are the policies the facility will follow:      VISITATION IS ON HOLD DUE TO OUTBREAK

VISITATION POLICY AND PROCEDURE    

Purpose:

To provide a safe and sanitary environment in which all resident’s and families are able to visit and see each other during the current COVID-19 health crisis.

Visitor Testing and Vaccination:

The risks associated with visitation will be explained to visitors and residents prior to the visitation commencing.  They will make an informed decision regarding visitation.

The facility strongly encourages but does not require visitors to comply with testing.  Facility will request visitors to complete COVID-19 testing approximately 72 hours prior to visitation or the Facility will offer testing prior to visit. 

All visitors must don/apply a well-fitting surgical mask upon entrance to the facility.  If visitor does not have a mask, the facility will provide a mask. 

Children of any age may visit.  Any child above the age of 2 will wear a mask.  Any child below the age of 12 will be accompanied by an adult.  One adult per child. 

The facility encourages visitors to become vaccinated when they have an opportunity. 

***Residents requiring Transmission Based Precautions should only receive virtual or window visits or Compassionate visits with adherence to Infection Control Measures.

Procedure for Visitation:

  1. The Facility will permit resident visitation under the following guidance: 
  2. All visitors must screen at the entrance of the building and be asked to complete a release form.
  3. All visitors will be asked to provide documentation of their COVID Vaccine status at each visit.  If visitor is fully vaccinated, In-Room Visitation will be allowed.  If unable to provide vaccination documentation, Facility will accommodate visit in designated visiting area.  Copies of vaccine records will not be maintained by facility.  Visitors must present their vaccination documentation at each visit.
  4. The facility does not require but strenuously encouraged all visitors to be tested for COVID 19 prior to their visit.  The facility will provide testing to all visitors.
  5. All visitors and residents must complete hand hygiene before and after all visits. 
  6. Visitors who fail any screening, or who do not follow guidance or facility protocol during their visit will be asked to leave promptly.  The resident involved will then be placed in Observation for at least 14 days on Droplet  and Contact Precautions. 
  7. Any resident who is currently under Droplet/Contact Isolation Precautions, will not be able to utilize in-person visitation.  They will receive virtual or window visits or Compassionate Visits (approved by Nursing Management only) with adherence to Infection Control Measures.
  8. The facility reserves the right to eliminate or further restrict visitation based on the outbreak status of the facility.
  9. When a new case of COVID is detected in either resident or staff, the facility will begin Outbreak Testing.  If the first round of testing (1POC and 1PCR for staff and 1PCR for resident) reveals no additional cases of COVID 19, then visitation can resume in resident areas not affected by positive cases.  If the first round of testing reveals one or more additional cases of COVID, then no Indoor Visitation will be allowed.  Continuation of Outdoor Visitation will be determined by Local Health Department. 
  10. If a resident is fully vaccinated, and their visitor/visitors are fully vaccinated, the visitor/visitors may go to the resident’s room for a private visit.   See below for further details regarding Vaccinated Res/Vaccinated Visitor guidelines. 
  11. If a resident if fully vaccinated, and their visitor/visitors are not fully vaccinated, they may have a visitor/visitors meet them in the lobby or outdoor patio for private visit.  See below for further details regarding Vaccinated Res/Unvaccinated Visitor. 
  12. If a resident is unvaccinated, they may have a visitor/visitors meet them in the lobby or outdoor patio for a private visit.  See below for further details regarding Unvaccinated Res guidelines.

 Procedure for Vaccinated Res/Vaccinated Visitor:

  1. Vaccinated Res/Vaccinated Visitor visitation will be daily, from 9am to 8pm, Monday through Friday and 9am to 6pm, Saturday and Sunday.  Visitors do NOT need to schedule their visits.  They may come at will.
  2. We ask for no more than 4 visitors at one time.  Visitors may ‘tag in/tag out’ to allow for several visitors at one time.
  3. The vaccinated visitor will don a well-fitting surgical mask as they utilize the most direct access to the resident room.  Surgical masks will be provided by the facility.
  4. If the resident resides in a semi-private room, Nursing staff will remove the roommate prior to visitation.  The visit should last no more than 2 hours as a courtesy to the roommate and their needs.  The honor system will be used for time keeping of visits.   If the roommate is unable to leave their room due to health concerns, the visitation cannot occur in the resident room.  Another private area will be provided by the facility. 
  5. If the resident being visited is in a private room, there is no limit to length of visit except for 8pm close of visiting hours. 
  6. Visitors and Resident will don and maintain a well-fitting mask during the entire visit.
  7. The vaccinated resident and their vaccinated visitor are able to leave the resident room to visit on facility grounds (outside) ONLY, however, all parties must don well-fitting surgical masks provided by the facility.  They must also, utilize the most direct exit, while not loitering or visiting other parts of the building or other residents.  Visitors are not allowed access to any other areas of the building.  IE:  lobbies, activity areas, rehab, hallways
  8. Upon exiting the resident room at the end of the visit, the visitor will don a well-fitting surgical mask to exit the building and exit the building utilizing the most direct egress. 

Procedure for Vaccinated Res/Unvaccinated Visitor:

  1. Vaccinated Res/Unvaccinated Visitor visitation will be Monday thru Saturday from 9am to 12 noon and on Tuesday evenings from 6pm to 8pm. 
  2. Visitors will be required to schedule their visit with the Receptionist at 301-733-6284. 
  3. The preference for visitation site for unvaccinated residents is outside.  However, if the resident is unable to tolerate an outdoor visit, the visit may occur in the lobby.
  4. If an Outdoor Visitation is not optimal due to weather or resident condition, Residents may have an Indoor Visit except for a few circumstances when visitation will be limited due to a high risk of COVID-19 transmission.  Those circumstances include:  unvaccinated residents if the County Positivity rate is >10% (CMS and/or Washington County Health Department) and <70% of the residents in the facility are fully vaccinated, or residents with confirmed COVID-19 infection regardless of vaccination status and continue in Transmission Based Precautions (Droplet/Contact), or Residents in Quarantine regardless of vaccination status, until they have met criteria for release from quarantine or Facility is in Outbreak Status.
  5. Only 1 outdoor visit will be allowed at one time in each area to allow Facility staff to focus on maintaining correct protocols during visits. 
  6. Areas of Visitation: 

For SNF/Assisted Living: Back patio and front veranda 

For Memory Care:  Memory Care Patio

  1. Only 2 visitors permitted per visit.
  2. Each visit is limited to 45 minutes.
  3. Social Distancing will be required unless vaccinated resident able to give consent for physical contact.
  4. All unvaccinated resident visits will be supervised by Facility personnel to monitor the visit for appropriate use of PPE, Social Distancing.  Residents and their visitor will be afforded as much privacy as possible. 
  5. Visitors and Resident will don and maintain a well-fitting mask during the entire visit.
  6. Before and after each visit, Facility personnel will utilize the appropriate disinfecting products to sanitize the visiting area.   IE: bleach wipes, Quaternary ammonium, Effersan
  7. When all visits are completed for the day, EVS will again sanitize the area with the appropriate disinfecting solution.  IE: Quaternary ammonium or Effersan

Procedure for Unvaccinated Res:

  1. Unvaccinated Res visitation will be Monday thru Saturday from 9am to 12 noon and on Tuesday evenings from 6pm to 8pm. 
  2. Visitors will be required to schedule their visit with the Receptionist at 301-733-6284. 
  3. The preference for visitation site for unvaccinated residents is outside.  However, if the resident is unable to tolerate an outdoor visit, the visit may occur in the lobby.
  4. If an Outdoor Visitation is not optimal due to weather or resident condition, Residents may have an Indoor Visit except for a few circumstances when visitation will be limited due to a high risk of COVID-19 transmission.  Those circumstances include:  unvaccinated residents if the County Positivity rate is >10% (CMS and/or Washington County Health Department) and <70% of the residents in the facility are fully vaccinated, or residents with confirmed COVID-19 infection regardless of vaccination status and continue in Transmission Based Precautions (Droplet/Contact), or Residents in Quarantine regardless of vaccination status, until they have met criteria for release from quarantine or Facility is in Outbreak Status.
  5. Only 1 outdoor visit will be allowed at one time in each area to allow Facility staff to focus on maintaining correct protocols during visits. 
  6. Areas of Visitation: 

For SNF/Assisted Living: Back patio and front veranda 

For Memory Care:  Memory Care Patio

  1. Only 2 visitors permitted per visit.
  2. Each visit is limited to 45 minutes.
  3. Visitors and Resident will don and maintain a well-fitting mask during the entire visit.
  4. All unvaccinated resident visits will be supervised by Facility personnel to monitor the visit for appropriate use of PPE, Social Distancing.  Residents and their visitor will be afforded as much privacy as possible. 
  5. Before and after each visit, Facility personnel will utilize the appropriate disinfecting products to sanitize the visiting area.   IE: bleach wipes, Quaternary ammonium, Effersan
  6. When all visits are completed for the day, EVS will again sanitize the area with the appropriate disinfecting solution.  IE: Quaternary ammonium or Effersan

Procedure for Compassionate Visits:

  1. The facility will allow Compassionate Visits as follows:
  • End of Life situations/Compassionate Care Situations.

***While end-of-life situations have been used as examples of compassionate care situations, the term “compassionate care situations” does not exclusively refer to end-of-life situations. Examples of other types of compassionate care situations include, but are not limited to:

  • A resident, who was living with their family before recently being admitted to a nursing home, is struggling with the change in environment and lack of physical family support.
  • A resident who is grieving after a friend or family member recently passed away.
  • A resident who needs cueing and encouragement with eating or drinking, previously provided by family and/or caregiver(s), is experiencing weight loss or dehydration.
  • A resident, who used to talk and interact with others, is experiencing emotional distress, seldom speaking, or crying more frequently (when the resident had rarely cried in the past).

***These visits will be determined by Infection Control Department with the assistance of Nursing Administration. 

  1. If an in-room visitation cannot be avoided for Compassionate Care Situations for a resident in a semi-room, all Infection Control Measures will be followed as possible. IE: roommate to be out of room during visit, room will be sanitized after visit then roommate can return to room; if roommate cannot be moved during visit, curtains will be pulled; Visitors will be educated to remain on their loved one’s side of room only, do not utilize BR while in room, etc.)
  2. End of Life visits may have 3 visitors permitted per visit.  Visitors may alternate if more than 3 visitors wish to visit.
  3. Other Compassionate Visits are permitted 2 visitors per visit.
  4. All visitors must be screened and meet the criteria to be allowed to visit.  Visitors will also be asked to complete a facility release form.
  5. All visitors and residents must complete hand hygiene before and after all visits.  Facility staff monitoring In Door visit will witness completion of the hand hygiene. 
  6. Length of Compassionate Visits will be determined on each individual occurrence by Director of Nursing/Assistant Director of Nursing or Nurse Management. 

COMMUNAL ACTIVITIES AND DINING          COMMUNAL DINING AND ACTIVITIES IS ON HOLD DUE TO OUTBREAK

  1. The facility will provide communal dining and/or activities programs  when appropriate.
  2. If a resident is unable to abide by core principles of Infection Prevention, they will be asked to dine in their rooms or abstain from communal Activities program.
  3. Residents will be required to perform hand hygiene prior to and after dining and activities.
  4. Residents will receive hand-hygiene before and after activities or dining.
  5. Residents will wear masks to, during and from all dining or activities programs.
  6. Residents who are in Transmission Based Precautions will abstain from communal dining and communal activities until Transmission Based Precautions are discontinued.
  7. Any equipment used for communal activities will be disinfected before and after use.
  8. Dietary staff will sanitize tables before and after meals.
  9. Activities personnel will sanitize tables before and after activities. 
  10. Residents who are fully vaccinated may dine and participate in activities without a face covering and are not required to social distance with any other participating residents during the dining or activity.  However, if any unvaccinated residents or unvaccinated staff are present during communal dining or activity, then all residents must social-distance and wear face coverings when not eating. 
  11. Fully vaccinated volunteers will be permitted to volunteer their services.  They must provide documentation of their vaccination status.
  12. Outside Group Activities may be held.  No singing or woodwind/brass presentations will be allowed.

MITIGATION PROCEDURES

STAFF CONDUCT:

  1. When washing uniforms and work clothes, wash and dry in hottest available setting.
  2. Frequent hand hygiene is required.  Soap and water for at least 40 seconds or alcohol-based hand sanitizer if soap and water is not available. 
  3. Every time you enter the building, you must complete hand hygiene. 
  4. Limit your foot traffic throughout the building.  If you do not need to be on a Nursing unit or in another part of the building, do not go.
  5. If you are sick, stay home.  Do not come to work sick.  Infection Control will contact you and monitor your symptoms. 
  6. All staff must don and maintain a surgical mask when entering facility.
  7. Masks are to be worn correctly at all times except during meal break times.  Anyone observed with incorrect application will be reminded of correct wear and if continued disregard is observed, will receive corrective action.
  8. Frequent cleaning and disinfection of your work area is expected.  If the area is soiled, you need to clean then disinfect.  Just spraying disinfectant on a dirty area does nothing.  Bleach solution requires a 1-minute contact time.  Quaternary Ammonium/Quat requires a 10-minute contact time.  High touch surface areas must be cleaned frequently.  Who is responsible for this?  YOU!  Environmental Services will supply units with pump sprays of bleach solution daily.  Once mixed, the bleach solution is only good for 24 hours.  Please use it to clean your workspaces frequently.  Focus on High Touch Surface Areas.  Phones, doorknobs, handrails, med/treatment carts, tables, desks, and keyboards to name a few.  IT has provided screen wipes to be used on computer screens and cell phones.  Once applied, allow the area to air dry.  If you have a resident with respiratory issues, do not use bleach, use Quat.  But remember, Quat requires 10 minutes contact time. 
  9. At the end of your shift, please put your soiled goggles in appropriate receptacles provided.  Do not take them home!  If you utilize a face shield, please use for 7 days.  Disinfect after each use daily and place in a receptacle in the auditorium.
  10. Practice Respiratory Etiquette.  If you need to cough or sneeze, please do so into a tissue, or elbow.  Wash your hands!!!!
  11. You must practice Social Distancing at all times.  (Remain at least 6 feet apart as allowable in most situations). This includes mealtimes when your mask is off.  YOU MUST SOCIAL DISTANCE!!
  12. When eating your meal, you must remain behind the shield to protect yourself from other staff persons.  Overflow tables will be in the Main Dining Room.  This means 2 staff persons per table.  If there are no free tables in the breakroom, you may go to the Main Dining room for your break time and sit at one of the tables with plastic shields. 
  13. Every staff member must screen upon entry to facility.  If your temp is 99.0 or above, you must alert your supervisor or Director.  Do not pass the screening station until approved by your Director/Supervisor and Infection Control (Angie Keebaugh or Marcia Frizzell).
  14. Staff must submit a vacation request form to their supervisor then Infection Control for any planned vacation out of the general area.  Staff will then receive instructions on precautions to take during this time.
  15. COVID testing of staff will be determined by Federal and State guidance.  
  16. You are expected to be swabbed at the times posted.  No special circumstances will be made for anyone.  If you do not get swabbed as directed, you cannot work, and you will receive disciplinary action up to and including termination. 
  17. Any contractor or non-staff clinician must provide documentation of a negative COVID test completed within the last 72 hours prior to being allowed access into the facility or proof of being fully vaccinated.   
  18. If staff are fully vaccinated (2 doses +14 days Pfizer or Moderna or Johnson and Johnson Janssen 1 dose +14 days), they need only to test if symptomatic or if facility is in Outbreak Status. 
  19. If staff are not fully vaccinated, they will be required to test at least weekly and according to CMS County Positivity rates.
  20. During your off time, the Facility requests that you follow mandated safety precautions, maintain Social Distancing and good hand hygiene to prevent opportunities of infection.
  21. Staff will be updated weekly with new or changed mitigation interventions.   
  22. All medication carts will have a container of disinfecting wipes and a bottle of hand sanitizer.
  23. All vital signs machines will have a container of disinfecting wipes and bottle of hand sanitizer in basket.
  24. All Mechanical lifts will have a container of disinfecting wipes and bottle of hand sanitizer in bag.  The lift will be disinfected each time after using on a resident.
  25. No more than 2 staff or other individuals in an elevator at a time. 
  26. If a staff member reports an exposure to a positive case of COVID-19 and is fully vaccinated, they will not be excluded from work as long as they remain asymptomatic.  If a staff member reports an exposure to a positive case of COVID-19 and is not fully vaccinated, a risk assessment will be completed by the Director of Infection Control or their designee.
  27. As of August 1, 2021, all staff will be required to be fully vaccinated or have a plan in place to become fully vaccinated as part of their employment.

RESIDENT CONDUCT:

  1. IL residents who live in the apartments in the Main Building, are asked to isolate themselves if they continue to go out of the facility.  They should not be mingling with AL or SNF residents. 
  2. Any resident from SNF or AL who has an outside appointment and returns, must wear a cloth mask when out of the rooms.  They must also receive a shower and change of clothes as soon as they return from their appointment.  They will also receive a COVID test (POC) weekly. 
  3. IL residents who live in the apartments in the Main Building, are asked to isolate themselves if they continue to go out of the facility.  They should not be mingling with AL or SNF residents. 
  4. All new admissions, readmissions and anyone who went to ER for evaluation for greater than 24 hrs., will be housed on the Observation Unit (Young Avenue, 1st Floor, Fahrney Hallway, 1st Floor) and assessed for COVID 19 signs and symptoms every shift.
  5. All new admissions, readmissions will be screened upon admit or return for COVID-19.  Nurses, this screen is under assessments in Matrix. 
  6. For the purpose of increased physical activity, on a limited basis and the facility is not in an Outbreak Status, residents may be allowed outside of their rooms or outside of the building if the following conditions are met:
  • Adequate staffing to supervise residents.  More than one resident can be outside of their room at a time, but they must be supervised, appropriate social distancing must be maintained, and they must not congregate in any area of the facility.  Ideally, facilities will schedule residents to be outside of their room one at a time.
  • Residents allowed outside of their room for physical activity should remain on their home unit or be escorted outside of the facility by the most direct route available.
  • Residents must be masked anytime they are out of their room, as feasible. Staff must also be wearing appropriate PPE.  ***If a resident comes out of their room and continually refuses to wear a face mask, they must socially distance from other residents (at least 6 feet at all times) and be monitored by staff.
  • Residents must stay at least 6 ft apart from others
  • Residents must perform hand hygiene before leaving their room and after returning
  • Residents being allowed outside for physical activity and fresh air should take the most direct route possible from their room to an outside location
  • Residents who remain on transmission-based precautions should not leave their rooms except for medically necessary purposes.  
  1. If not on Outbreak Status (14 consecutive days without an active staff or resident case of COVID), the facility will allow small group activities for the promotion of Social and Physical Activity.  This will be on a limited basis with the following restrictions:
  • No more than 5 residents per Activity
  • Residents must wear masks.  If a resident is noncompliant with mask use, they may not participate in group activities
  • Social Distancing protocols must be followed at all times, 6 feet at a minimum.  If a resident in noncompliant with social distancing, they may not participate in group activities
  • Residents must be supervised at all times by a staff member
  • The area the Activity is held will be cleaned prior to event and after event using approved cleaning methods
  • All group activities will be held on each unit.  Residents will not be transported to other areas of the facility
  • Residents on Transmission Based Precautions cannot participate in the small group activity until cleared from Transmission Based Precautions
  • No singing will be allowed as a small group activity
  • If any activity includes the use of props, games or equipment, said props, games and/or equipment will be disinfected before and after use
  • Residents must complete hand hygiene before and after each group activity.
  1. If they come out of their room, they need to wear a facemask and social distance the entire time.  Document all refusals of facemask or social distancing.  This must be care planned!  No exceptions!
  2. Residents need to wear facial covering when a staff person is in their room.  These will be washed when soiled and at least weekly. 
  3. All new admissions need to enter the building at the Ambulance Entrance in the basement.  They cannot come in through the reception area.
  4. Any resident being discharged, will need to utilize the Ambulance Entrance as an exit point as well.   We must limit residents as much as we can to potential exposure.
  5. SNF and ALU residents will be assessed daily by a nurse and complete the COVID Assessment in EHR.  Does not need to be completed by RN at this time. LPN may complete.
  6. All new admissions for SNF who are unvaccinated will be housed on Young Avenue on 1st Floor Nursing for at least a 14-day observation period in Transmission Based Precautions (Contact/Droplet).  These residents need to remain in their rooms.  If they come out of their rooms, they must wear a mask and they must be the only resident in the hallway at that time.  If they need to exit the unit and go to another area or maybe an appointment, always choose the route with the least number of potential interactions with others.  If a new admission has had a COVID infection within the last 90 days and is not in Transmission Based Precautions, they may be admitted to General Population and not to the Observation Area.  If a new admission for SNF is fully vaccinated and is not having symptoms of COVID, they may be admitted to General Population.
  7. If a resident is in Transmission Based Precautions, (Contact Isolation or Droplet Isolation) they should not have outdoor or indoor visits with family.  They need to remain in their rooms.  They will be offered virtual visits, or window visits if available or Compassionate Visits as approved.  
  8. All window visits must be scheduled through Activities.  This also includes Face Time. 
  9. Staff are not required to wear gowns when caring for residents in the General Population unless they are in Transmission Based Precautions due to infection of another source.  The Observation Unit and COVID Unit are areas where gown use is still in effect.  However, if a resident in General Population is in typical Transmission Based Precautions, (Contact or Droplet Isolation) we need to abide by that protocol.  IE:  If a resident is located anywhere other than the Observation Unit, and they are in Droplet Isolation, you follow Droplet Isolation procedures:  mask, goggles, disposable gown, and gloves to enter the room. 
  10. Any Aerosol Generating Procedure requires that staff don full PPE prior to initiation of procedure and close the resident room door during procedure.  IE: med aerosols and suctioning.  PPE for any aerosol causing procedure is disposable gown, gloves, N95 and face shield.
  11. The use of med aerosol medications is strongly discouraged.  Nurses, please encourage Metered Dose Inhalers along with spacer use when physicians or nurse practitioners are making orders. 
  12. Any resident with a significant change in condition must be seen by clinician within a timely manner.  Either in person or via telehealth.
  13. Residents housed in general population, will have a COVID Assessment daily.
  14. LPN’s can complete the COVID Assessment.
  15. Any Resident who is given the diagnosis of Pneumonia, of an infectious nature, will receive the following tests:  COVID Nasal Swab, Rapid Flu swab or Influenza PCR, sputum culture to include Legionella, and Legionella/Streptococcus pneumoniae urine antigen test.  
  16. Any resident who displays respiratory or gastrointestinal symptoms will have Transmission Based Precautions, Droplet/Contact initiated and remain until symptoms have resolved.
  17. Nursing, Rehab, EVS, Activities and Maintenance will be required to complete Quarterly PPE Doffing and Donning Demonstration training with Laura Cheung.  Also, all staff will have monthly refresher questionnaires to be completed.  All staff must comply, or corrective action will be given.
  18. Residents and their families or legal representatives will be updated weekly with facility status and new or changed mitigations interventions. 
  19. COVID testing of residents will be determined by Federal and State guidance.  

OBSERVATION/PUI PROCEDURES:

  1. All new admissions who are not fully vaccinated will be admitted to a private room with private bath (may be admitted to private room with Jack and Jill BR if resident sharing the BR is also not fully vaccinated and in Droplet/Contact Isolation with the same admission date) under Droplet and Contact Isolation Precautions (Transmission Based Precautions).  Droplet and Contact Isolation signs will be hung at their doorway.  A PPE supply hanger will be placed on their door. 
  2. Observation/PUI Residents will be assessed daily for COVID 19 infection.
  3. Upon entry to an Observation/PUI room, all staff will don a fit-tested N95 mask, goggles or face shield, then in doorway of room, will don a gown and gloves.  Upon leaving the resident room, staff member will appropriately doff all PPE in the doorway of the resident room. When doffing your PPE (removing), you cannot come into the hallway.  You should doff in the doorway.  There will be a large trashcan at all room doors for you to place your soiled PPE in.  Then complete hand hygiene upon exiting the room.
  4. All Observation/PUI resident room door will be closed.  If a resident requires door to be open, can only be left open after other interventions have been initiated and failed.  All must be care planned.
  5. IFC will notify staff when these residents can come out of Transmission Based Precautions.  If the resident remains free from COVID 19 symptoms for 14 days, they may be removed.
  6. If you are not involved with direct patient care or your job does not require you to visit with residents who are in Observation/PUI should avoid going into these rooms. 
  7. Residents designated as Observation/PUI should not leave their rooms.  If they must exit the room, they must wear a mask at all times and utilize the best way to get to their destination with the least possible exposure to other residents and staff.
  8. Frequent cleaning of high touch surface areas is required.
  9. If your job duties include visiting residents in Observation/PUI and visiting residents in other parts of the unit, please see the Observation/PUI residents last. 
  10. Multi use devices should not be used on Non-Observation Unit Residents after being used on Observation/PUI Residents without being disinfected.  We should be using dedicated devices on the Observation Unit.  IE:  vital signs equipment. 

 

COVID UNIT:

  1. The COVID Unit will have dedicated staff.
  2. Potential COVID Unit will be rooms 137, 138, 139, and 140. 
  3. Residents residing on the COVID Unit will receive a head-to-toe assessment every shift along with vital signs assessment every 4 hours.  If any change in condition for the resident is assessed, a Change in Condition will be initiated.
  4. Staff will screen upon entry, every 4 hours and upon exit of COVID Unit
  5. Contact Tracing will be completed for anyone who may have been in contact with the positive resident case.  Residents and staff.
  6. Residents on the COVID unit will be in Transmission Based Precautions, Droplet and Contact.  Both signs will be placed at each room door.
  7. Staff will be required to wear PPE during each contact with any resident housed on the COVID Unit.  Disposable Gown, Gloves, Face Shield, Fit-Tested N95 mask, and gloves.
  8. Staff will be required to perform increased environmental cleaning with EPA-List N approved disinfectants.
  9. Frequent Hand Hygiene will be completed by all staff.
  10. Staff will not have personal items on the COVID Unit.
  11. Staff will enter and exit from the dedicated entrances.
  12. Staff on the COVID Unit will not enter other areas of the facility.
  13. Staff who are not providing direct care to the COVID residents are not allowed entry to the COVID Unit.
  14. Dedicated equipment will be used on the COVID unit.  Multi use devices will not be used. IE: stethoscopes, B/P cuffs, pulse ox.
  15. Residents need to remain in their rooms.
  16. Resident room doors on the COVID Unit will remain closed at all times.
  17. You should disinfect your face shield between residents.  Wipes will be provided.
  18. When doffing your PPE (removing), you cannot come into the hallway.  You should doff in the doorway.  There will be a large trashcan at all room doors for you to place your soiled PPE in.  Then complete hand hygiene upon exiting the room.
  19. Soiled laundry will be housed at the bottom of the stair well in the basement.  Laundry staff will don gown, gloves, mask, goggles to remove bagged soiled laundry, place in their soiled linen cart, cover and transport to laundry.  Laundry staff will place soiled linens in washer, causing the least amount of disturbance to linens to prevent the spread of contaminants. 

 

 

Angela Keebaugh, LPN/IP/RAC-CT

Director of Quality Assurance/Infection Control

Fahrney Keedy Senior Living

8507 Mapleville Road

Boonsboro, MD 21713

301-733-6284

301—671-5026

[email protected]