May 13, 2022
Dear Resident/Family/Resident Representative,
- As of last letter, we have had 5 staff cases of COVID. All have been symptomatic. They remain off work until they meet Return to Work Criteria from CDC.
- All residents of SNF were swabbed on Wednesday, and all swabs returned with Negative Results.
- We will continue to test all staff of SNF and all residents of SNF next week.
- Our 1st potential day to come off of Outbreak Status would be 5-27-22.
- Due to the increase in Community Transmission from MODERATE to SUBSTANTIAL, we will begin testing unboosted staff twice weekly.
- We have updated our protocol for residents who leave the facility for 24 hours or longer. Please see the highlighted areas below (Visitation Policy and Procedure, #23 and #24).
COVID Status Update:
We continue to offer COVID vaccines to our residents and staff. Our current rate of resident vaccination is 97.5% in the Skilled Nursing Center. Our current rate of resident vaccination is 97.6% in the Assisted Living Centers. Our current rate of staff vaccination is 100%. This information is reported daily by the facility to Maryland Department of Health via PROPS and weekly 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 .
We have been reporting County Positivity Rates to you since the beginning of the Pandemic. However, these numbers are no longer available for comparison. Going forward, the facility will report the following to you:
Weekly Metrics used to Determine COVID 19 Community Level:
For the week of May 13:
COMMUNITY TRANSMISSION: SUBSTANTIAL
Case Rate per 100,000: 62.23
New COVID Admits per 100,000: 3.7
% Staffed In-Patient Beds in use by Patients with Confirmed COVID 19: 1.5
The above information can be found at:
As stated above, CMS has released new guidance for testing. The facility will test according to guidance and Outbreak Status. We have been testing unboosted staff once a week, however, with the increase of Community Transmission, we will not test twice weekly going forward. We also test anyone who is symptomatic, resident or staff.
We continue to strongly encourage visitor testing. Visitors are not required to be tested nor are they required to be vaccinated to visit. Visitors are not required to show proof of vaccination either.
With the recent addition of a 2nd booster, the facility has set up 2 more COVID vaccine clinics. This will be for Skilled, Assisted Living and Independent Living residents, and staff. The dates are May 24, from 2p-5p, and June 6. We are attaching the consents to this letter if you would like to send in your consent for yourself (residents) or your loved one.
Any IL resident may receive rapid, Point of Care testing upon request. If you would require PCR testing, we suggest going to a Meritus Care Center. Please contact Kathy Neville with your requests.
If you are interested in a 2nd booster, please contact Kathy Neville. I am planning to have Independent Living residents to get 2nd boosters on May 24. We will give you times as we get closer to the date.
We continue to see a rise in COVID cases, as evidenced by our change from MODERATE Community Transmission to SUBSTANTIAL. When you visit your loved on here, please remember, if you are sick, stay home, please get vaccinated, maintain social distancing, and screen/test.
Angie Thompson LPN/IP Marcia Frizzell LPN/IP
Director of Quality Assurance and Infection Control Quality Care Coordinator/ Infection Preventionist
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.
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:
- 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.
- When the local jurisdiction is in HIGH levels of community transmission of COVID019, all visitors, regardless of COVID vaccination status, will be asked to supply proof a negative COVID test obtained within the last 72 hours of entry into the facility or agree to be tested onsite using a POC, Point of Care, Rapid test.
- If the visitor refuses the request to provide proof of a negative test or take a test, the visitor shall wear a well-fitting mask and maintain physical distance from all residents and staff in accordance with CMS and CDC guidance. No cloth masks. The facility can provide a surgical mask if visitors do not have a well-fitting mask. Visitors who have tested positive for COVID-19 within the past 90 days are exempt from testing upon showing their positive test result that is more than 5 days from the time of visit as long as they are no longer exhibiting symptoms.
- 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, 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.
- 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 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.
- 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.
- 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 much as possible and to the best of their abilities.
- If a resident leaves the facility for 24 hours or longer, and are up to date with all recommended vaccines, will be required to test via POC system immediately upon return and then 5-7 days later.
- If a resident leaves the facility for 24 hours or longer and are not up to date with all of the recommended vaccines, they will be required to be placed in quarantine (even if they have a negative test upon return) for 10 days and will be required to test via POC system immediately upon return and then 5-7 days later.
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, except when eating.
- 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.
- 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 who is unvaccinated 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.