December 17, 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.
- Our resident, who tested positive for COVID on 12/6/21, has been released from Transmission Based Precautions as of this morning.
- Current COVID Numbers: Residents-1 resident positive on 12/6/21, Staff: 1 staff positive on 12/2/21, 4 staff positives on 12/9/21, and 1 staff positive on 12/13/21.
- We had 1 staff member report being positive for Influenza A this week. This staff person is off pending improvement of symptoms and clearance to return to work. This does not change our Outbreak Status or Visitation.
- Governor Hogan announced yesterday that all Long-Term Care Facilities are required to offer approved or authorized COVID-19 therapeutic treatments-including Monoclonal Antibody treatments-to residents upon identification of an outbreak. Monoclonal Antibodies can either be given intravenously or through subcutaneous injections. Monoclonal Antibodies can be given to resident due to a potential exposure or an active infection. They have shown to decrease the severity of illness and the length of illness. By administering the Monoclonal Antibodies in Nursing Homes, the Governor feels this will alleviate some of the burden on Acute Care Hospitals. Fahrney Keedy has already been doing this. Our pharmacy, Pharmacare, comes to our facility, administers the medication and monitors the resident for 1 hours following administration. Consent for administration must be obtained from the resident or their Resident Representative prior to administration.
On November 26, 2021, the World Health Organization classified a new COVID variant, B.1.1.521, as a Variant of Concern and has named it Omicron. It has now been detected in over 20 States. The following is from the CDC website for Omicron:
Infection and Spread
- How easily does Omicron spread? The Omicron variant likely will spread more easily than the original SARS-CoV-2 virus and how easily Omicron spreads compared to Delta remains unknown. CDC expects that anyone with Omicron infection can spread the virus to others, even if they are vaccinated or don’t have symptoms.
- Will Omicron cause more severe illness? More data are needed to know if Omicron infections, and especially reinfections and breakthrough infections in people who are fully vaccinated, cause more severe illness or death than infection with other variants.
- Will vaccines work against Omicron? Current vaccines are expected to protect against severe illness, hospitalizations, and deaths due to infection with the Omicron variant. However, breakthrough infectionsin people who are fully vaccinated are likely to occur. With other variants, like Delta, vaccines have remained effective at preventing severe illness, hospitalizations, and death. The recent emergence of Omicron further emphasizes the importance of vaccination and boosters.
- Will treatments work against Omicron? Scientists are working to determine how well existing treatments for COVID-19 work. Based on the changed genetic make-up of Omicron, some treatments are likely to remain effective while others may be less effective.
We have the Tools to Fight Omicron
Vaccines remain the best public health measure to protect people from COVID-19, slow transmission, and reduce the likelihood of new variants emerging. COVID-19 vaccines are highly effective at preventing severe illness, hospitalizations, and death. Scientists are currently investigating Omicron, including how protected fully vaccinated people will be against infection, hospitalization, and death. CDC recommends that everyone 5 years and older protect themselves from COVID-19 by getting fully vaccinated. CDC recommends that everyone ages 18 years and older should get a booster shot at least two months after their initial J&J/Janssen vaccine or six months after completing their primary COVID-19 vaccination series of Pfizer-BioNTech or Moderna.
Masks offer protection against all variants. CDC continues to recommend wearing a mask in public indoor settings in areas of substantial or high community transmission, regardless of vaccination status. CDC provides advice about masks for people who want to learn more about what type of mask is right for them depending on their circumstances.
Tests can tell you if you are currently infected with COVID-19. Two types of tests are used to test for current infection: nucleic acid amplification tests (NAATs) and antigen tests. NAAT and antigen tests can only tell you if you have a current infection. Individuals can use the COVID-19 Viral Testing Tool to help determine what kind of test to seek. Additional tests would be needed to determine if your infection was caused by Omicron. Visit your state, tribal, local, or territorial health department’s website to look for the latest local information on testing.
Self-tests can be used at home or anywhere, are easy to use, and produce rapid results. If your self-test has a positive result, stay home or isolate for 10 days, wear a mask if you have contact with others, and call your healthcare provider. If you have any questions about your self-test result, call your healthcare provider or public health department.
Until we know more about the risk of Omicron, it is important to use all tools available to protect yourself and others.
What CDC is Doing to Learn about Omicron
Virus CharacteristicsCDC scientists are working with partners to gather data and virus samples that can be studied to answer important questions about the Omicron variant. Scientific experiments have already started. CDC will provide updates as soon as possible.
In the United States, CDC uses genomic surveillance to track variants of SARS-CoV-2, the virus that causes COVID-19 to more quickly identify and act upon these findings to best protect the public’s health. CDC established multiple ways to connect and share genomic sequence data being produced by CDC, public health laboratories, and commercial diagnostic laboratories within publicly accessible databases maintained by the National Center for Biotechnology Informationexternal icon (NCBI) and the Global Initiative on Sharing Avian Influenza Dataexternal icon (GISAID). If a variant is circulating at 0.1% frequency, there is a >99% chance that it will be detected in CDC’s national genomic surveillance.
COVID Status Update:
We continue to offer COVID vaccines to our residents and staff. Our current rate of resident vaccination is 93.3% 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 100%. 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 . Please be aware that the above percentages may not be reflected on the site but will be shown when site is updated.
Our County Positivity Rate is currently 12.9% Frederick County is 8.6%. Garrett County is 13.7%. Allegany County is 10.2%. Franklin Co, Pa is 20.8%. Berkeley County, WV is 16.7%. Jefferson County, WV is 18.0%.
Washington County continues to be the only county in Maryland, at this time, which has High levels of Community Transmission of COVID. Other statistics for Washington County are as follows:
***Due to a data breach at Maryland Department of Health causing widespread computer outages, the below information is not available.
For the week of November 17th:
Total Cases: no reported data
Care Rate per 100K: no reported data
%Positive: no reported data
Deaths: no reported data
%Eligible Population fully vaccinated: no reported data
New Hospital Admissions: no reported data
The above information can be found at:
We will have another COVID Vaccine Booster Clinic for residents and staff on January 3rd, from 9am to 12 noon.
At this time, we follow CMS guidance for routine 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 2 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.
At this time, we are testing weekly due to Outbreak Status.
If anyone has not received their COVID booster or Influenza vaccines, please make Kathy Neville aware and we will get you set up.
We are monitoring the Omicron situation closely. We encourage EVERYONE to wear masks, social distance and wash hands frequently. If you are sick, stay home!! Recently, Governor Hogan announced a requirement for Acute Care Hospitals. As hospital beds around the State are filling up at an alarming rate with COVID cases, Hospitals must plan for different stages of a COVID surge. We, as a facility, are monitoring this situation closely as we are affected by it. As the hospitals resources become more strained, Nursing Homes need to prepare to step up and assist hospitals with discharges and placement of non-critical patients. We did this during the 2020 COVID surge as well.
God Bless you all this Holiday Season!!!!
Angie (Keebaugh) Thompson LPN/QCP/IP
Director of Quality Assurance and Infection Control
Marcia Frizzell LPN/IP
Quality Care Coordinator/ Infection Preventionist
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.
For visitation, here are the policies the facility will follow:
VISITATION POLICY AND PROCEDURE
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 Public Health Emergency (PHE).
The Facility will permit resident visitation under the following guidance:
- All visitors must abide by the Core Principles of COVID-19 Infection Prevention.
- Any visitor who has had a positive viral test for COVID-19, symptoms of COVID-19 or currently meets the criteria for quarantine, should not enter the facility.
- Hand Hygiene will be performed prior to each visit and after each visit.
- Face coverings or mask (covering the mouth and nose) and physical distancing at least 6 feet between people at all times, in accordance with CDC guidance.
- If the Visitor is not able to abide by the Core Principles of COVID-19 Infection Prevention, they will not be permitted to visit and/or will be asked to leave.
- All Visitors will apply a well-fitting surgical mask prior to coming into the building. If the visitor does not have a well-fitting surgical mask, the facility will provide as needed. No cloth masks allowed.
- All Visitors are required to be screened. They will complete the Facility Screening form. If the Visitor does not complete or does not pass the screening questions, they will be asked to leave immediately
- While the Facility encourages visitations during the hours of 8am to 8pm, Visitation can occur at any time at the preference of the resident.
- The frequency and length of visits are at the discretion of the visitor along with the preference of the resident.
- There is no limit to number of visitors at one time for each resident, the Core Principles of COVID-19 Infection Prevention must be observed. Specifically, physical distancing 6 feet between people at all times, in accordance with CDC guidance.
- Large parties or events should be avoided where physical distancing cannot be observed
- While visitors are not required to be tested prior to admittance, the facility does encourage any unvaccinated visitor to have at least an antigen test on their own, within the last 2-3 days prior to visitation.
- The facility will inquire about the visitor’s vaccination status, but it is not required as a condition of vaccination. If the visitor declines to answer, they should wear a well-fitting surgical mask at all times during their visit.
- If a visitor or resident is unvaccinated or not fully vaccinated, Outdoor Visitation is recommended but not required. Weather conditions and resident status will affect the feasibility of Outdoor Visitation. If Outdoor Visitation is not optimal, Visitors may proceed to the resident’s room for an in-room visit.
- If the Community Transmission Level is HIGH, all residents and visitors, regardless of vaccine status, should wear a well-fitting surgical mask at all times and physically distance at all times.
- If the Community Transmission Level is LOW to MODERATE, residents and visitors are encouraged to wear masks and physically distance, especially if the resident is at risk for severe disease or are unvaccinated during their visit.
- If the resident and all of their visitors are fully vaccinated, and the resident is not moderately or severely immunocompromised, all in the visiting party, including the resident may choose not to wear a mask and may have close, physical contact.
- All visitors will access the resident room utilizing the most direct access. Visitors will not stop at any other resident rooms. Visitors will keep their mask in place while around all other residents and any staff member.
- While not recommended, residents who are on Transmission Based Precautions, or Quarantine, are able to receive visitors. These visits should only occur in the resident room . The visitor and resident will wear a well-fitting surgical mask at all times and maintain physical distancing more than 6 feet. Prior to visiting any resident in Transmission Based Precautions, the visitor will be made aware of the potential personal risk of visiting and the precautions necessary to prevent infection in order to visit the resident.
- During an Outbreak Situation, the facility will abide by Health Department recommendations on visitation.
- Compassionate Visits continue to be allowed at any time.
- Any visitation in a shared, semiprivate room is discouraged to protect the health of resident’s roommate. However, if it cannot be prevented, the curtain around the resident and their visitors will be closed to provide a barrier around their visitation. This will also aid in privacy.
COMMUNAL ACTIVITIES AND DINING
- The facility will provide communal dining and/or activities programs when appropriate.
- 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.
- Residents will be required to perform hand hygiene prior to and after dining and activities.
- Residents will receive hand-hygiene before and after activities or dining.
- Residents will wear masks to, during and from all dining or activities programs.
- Residents who are in Transmission Based Precautions will abstain from communal dining and communal activities until Transmission Based Precautions are discontinued.
- Any equipment used for communal activities will be disinfected before and after use.
- Dietary staff will sanitize tables before and after meals.
- Activities personnel will sanitize tables before and after activities.
- 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.
- Resident numbers to activities are not limited however, physical distancing must be observed at all times. If physical distancing cannot be maintained with a large group, a decreased number of residents will be required.
- Fully vaccinated volunteers will be permitted to volunteer their services. They must provide documentation of their vaccination status.
- Outside Group Activities may be held. No singing or woodwind/brass presentations will be allowed during HIGH levels of Community Transmission.
- When washing uniforms and work clothes, wash and dry in hottest available setting.
- 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.
- Every time you enter the building, you must complete hand hygiene.
- 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.
- If you are sick, stay home. Do not come to work sick. Infection Control will contact you and monitor your symptoms.
- All staff must don and maintain a surgical mask when entering facility. No cloth masks will be allowed.
- 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.
- 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.
- 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.
- Practice Respiratory Etiquette. If you need to cough or sneeze, please do so into a tissue, or elbow. Wash your hands!!!!
- 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!!
- 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.
- 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).
- COVID testing of staff will be determined by Federal and State guidance.
- 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.
- 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.
- 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.
- If staff are not fully vaccinated, they will be required to test at least weekly and according to CMS Community Transmission Rates.
- 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.
- Staff will be updated weekly with new or changed mitigation interventions.
- All medication carts will have a container of disinfecting wipes and a bottle of hand sanitizer.
- All vital signs machines will have a container of disinfecting wipes and bottle of hand sanitizer in basket.
- 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.
- No more than 2 staff or other individuals in an elevator at a time.
- 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.
- 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.
- All new admissions, readmissions will be screened upon admit or return for COVID-19. Nurses, this screen is under assessments in Matrix.
- Any resident who is unvaccinated or not fully vaccinated, will be placed in a private room under Transmission Based Precautions (Droplet/Contact) for at least 14 days upon admission. If they remain COVID-19 symptom free, they may transfer to a room in General Population and be removed from Transmission Based Precautions.
- Any resident who is fully vaccinated or has had a COVID-19 infection within the last 90 days and has been released from Transmission Based Precautions, may be admitted to a General Population Room.
- If a resident comes 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!
- Residents need to wear facial covering when a staff person is in their room.
- 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.
- 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 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.
- All window visits must be scheduled through Activities. This also includes Face Time.
- 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/PUI Residents 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.
- 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.
- 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.
- Any resident with a significant change in condition must be seen by clinician within a timely manner. Either in person or via telehealth.
- Residents housed in general population, will have a COVID Assessment daily.
- LPN’s can complete the COVID Assessment.
- 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.
- Any resident who displays respiratory or gastrointestinal symptoms will have Transmission Based Precautions, Droplet/Contact initiated and remain until symptoms have resolved.
- 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.
- Residents and their families or legal representatives will be updated weekly with facility status and new or changed mitigations interventions.
- COVID testing of residents will be determined by Federal and State guidance.
- 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.
- Observation/PUI Residents will be assessed daily for COVID 19 infection.
- 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.
- 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.
- 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.
- 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.
- 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.
- Frequent cleaning of high touch surface areas is required.
- 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.
- 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.
- The COVID Unit will have dedicated staff.
- Potential COVID Unit will be rooms 137, 138, 139, and 140.
- 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.
- Staff will screen upon entry, every 4 hours and upon exit of COVID Unit
- Contact Tracing will be completed for anyone who may have been in contact with the positive resident case. Residents and staff.
- Residents on the COVID unit will be in Transmission Based Precautions, Droplet and Contact. Both signs will be placed at each room door.
- 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.
- Staff will be required to perform increased environmental cleaning with EPA-List N approved disinfectants.
- Frequent Hand Hygiene will be completed by all staff.
- Staff will not have personal items on the COVID Unit.
- Staff will enter and exit from the dedicated entrances.
- Staff on the COVID Unit will not enter other areas of the facility.
- Staff who are not providing direct care to the COVID residents are not allowed entry to the COVID Unit.
- Dedicated equipment will be used on the COVID unit. Multi use devices will not be used. IE: stethoscopes, B/P cuffs, pulse ox.
- Residents need to remain in their rooms.
- Resident room doors on the COVID Unit will remain closed at all times.
- You should disinfect your face shield between residents. Wipes will be provided.
- 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.
- 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.