12-24-2021 Covid-19 Update

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December 24, 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: 

  • Our last staff positive was 12/21/21. Our totals are as follows with this outbreak:  1 resident tested positive on 12/6/21.  7 staff members with the last positive on 12/21/21.
  • We have 10 staff tests and 85 resident tests PCR tests pending. Our lab is closed from today until Monday, in observance of the holiday.  We will likely not receive those pending results until Monday afternoon.
  • Some details of our Visitation Policy have changed. Highlighted areas below indicate changes.
  • We will be testing staff and residents Week of 12/27 and Week of 1/3. If we have further positive cases, we will continue testing until we are 14 days without a new case of COVID. 

 

OMICRON:

Since late November, we have been watching the Omicron Variant of COVID.  It is not in all 50 States.  The study of this variant continues.  Here is what we know:

  • The Omicron Variant seems to be more transmissible than the original COVID virus. They are still studying it in relation to the DELTA variant. 
  • Omicron is the most dominant variant Maryland.
  • Omicron can have the full spectrum of illness, from asymptomatic, mild symptoms, to hospitalization and/or death.
  • Initial reports suggest that Omicron is less severe comparted to Delta. With this being said, if we have more cases, more cases mean more hospitalizations.  More hospitalizations mean our health care system will be overburdened.  If our health care system is overburdened, that means patients won’t get the appropriate level of care that they require.  This means more cases of death in vulnerable populations. So, it’s early to tell whether or not Omicron is more or less severe, but we do have some initial reports that it is less severe. Now, don’t be fooled. Even if we have a virus that causes less severe disease, this virus can affect vulnerable populations. And we know people with underlying conditions, people of advanced age, if they are infected with any variant of SARS-CoV-2, including Omicron, they are at an increased risk of developing severe disease. So, it is really critical that even if we do see more mild disease, we still do everything that we can to reduce transmission in all populations, people who are vaccinated, as well as people who are not vaccinated. In terms of disease presentation, there are many studies that are underway that are looking at this and people who are infected with Omicron compared to other variants. We have not seen a change in the disease profile. For example, we haven’t seen a change in the symptoms that people present with Omicron compared to Delta. So you won’t be able to tell the difference. So, the best thing for you to do is to keep yourself safe, get vaccinated when you can and make sure that you take steps to reduce your exposure to this virus
  • There isn’t a clear picture to determine if the vaccine is effective against Omicron. However, it is better to be vaccinated than not.
  • Studies are proving that Abbott’s Binax NOW rapid antigen tests do detect the Omicron Variant. The facility uses the Binax NOW cards to test any staff or residents who are symptomatic. 
  • In the past, Monoclonal Antibodies, an IV infusion or subcutaneous injection, were a very successful treatment tool in the fight against COVID. Recent studies have shown that 2 of the 3 authorized Monoclonal Antibodies (MAB) do not work with the Omicron variant (Casirivimab/imdevimab, also known as REGEN-COV, and bamlanivimab/etesevimab) .  Sotrovimab has been the only MAB to demonstrate activity against the Omicron Variant.  The supplies of Sotrovimab are being recommended for prioritized use.  It should be given to individuals over the age of 65 or older, and individuals who are moderately to severely immunocompromised. 
  • Maryland Department of Health has contacted the facility to assure assistance, if needed, in obtaining Sotrovimab for treatment of any resident cases.

The above information is from CDC and WHO articles.

 

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 11.2%  Frederick County is 7.1%. Garrett County is 13.8%. Allegany County is 5.7%. Franklin Co, Pa is 20.4%. Berkeley County, WV is 17.4%. Jefferson County, WV is 17.6%.

 

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 has limited information. 

 

 

For the week of December 24th:

Total Cases:  no reported data

Care Rate per 100K:  no reported data

%Positive:  15.77

Deaths:  no reported data

%Eligible Population fully vaccinated:  58.9

New Hospital Admissions:  no reported data

 

The above information can be found at: 

https://covid.cdc.gov/covid-data-tracker/#county-view|Maryland|24043|Risk|community_transmission_level 

Vaccines/Boosters

We will have another COVID Vaccine Booster Clinic for residents and staff on January 3rd, from 9am to 12 noon.

Testing:

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.

 

Independent Living

If anyone has not received their COVID booster or Influenza vaccines, please make Kathy Neville aware and we will get you set up.

 

IN CLOSING

Again, 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!!

 

 

God Bless you all this Holiday Season!!!! 

 

Respectfully,

Angie (Keebaugh) Thompson  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 12-24-21

For visitation, here are the policies the facility will follow:      

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 Public Health Emergency (PHE).

The Facility will permit resident visitation under the following guidance: 

  1. 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.
  1. 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.
  2. 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.
  3. 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
  4. While the Facility encourages visitations during the hours of 8am to 8pm, Visitation can occur at any time at the preference of the resident.
  5. The frequency and length of visits are at the discretion of the visitor along with the preference of the resident.
  6. There is no limit to number of visitors at one time for each resident, however, 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.
  7. Large parties or events should be avoided where physical distancing cannot be observed
  8. 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.
  9. 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.
  10. 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.
  11. 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.
  12. 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.
  13. 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 as long as other residents are not within 6 feet. The Facility recommends mask-use during the entire visit, however, in observance of a resident’s rights, if the resident so chooses, may remove their mask if fully vaccinated.
  14. 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.
  15. 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.
  16. During an Outbreak Situation, the facility will abide by Health Department recommendations on visitation.
  17. Compassionate Visits continue to be allowed at any time.
  18. 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.
  19. Residents may leave the facility with their loved ones for outings. Families are encouraged to be fully vaccinated, and social distance as much as possible.  Masks are encouraged, especially when riding in a car.  Families and residents are encouraged to follow Infection Control measures as mush as possible and to the best of their abilities. 

 

 

 

COMMUNAL ACTIVITIES AND DINING         

  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, except when eating.
  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. 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.
  12. Fully vaccinated volunteers will be permitted to volunteer their services. They must provide documentation of their vaccination status.
  13. Outside Group Activities may be held. No singing or woodwind/brass presentations will be allowed during HIGH levels of Community Transmission.

 

 

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. No cloth masks will be allowed.
  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. COVID testing of staff will be determined by Federal and State guidance.
  15. 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.
  16. 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.
  17. 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. 
  18. If staff are not fully vaccinated, they will be required to test at least weekly and according to CMS Community Transmission Rates.
  19. 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.
  20. Staff will be updated weekly with new or changed mitigation interventions.
  21. All medication carts will have a container of disinfecting wipes and a bottle of hand sanitizer.
  22. All vital signs machines will have a container of disinfecting wipes and bottle of hand sanitizer in basket.
  23. 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.
  24. No more than 2 staff or other individuals in an elevator at a time.
  25. 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.
  26. 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. All new admissions, readmissions will be screened upon admit or return for COVID-19. Nurses, this screen is under assessments in Matrix.
  2. 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.
  3. 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.
  4. 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!
  5. Residents need to wear facial covering when a staff person is in their room.
  6. 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.
  7. 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.
  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/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.
  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.