5-5-2023 Covid-19 Update

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May 5, 2023

 

Dear Resident/Family/Resident Representative,

 

As required by Maryland Department of Health (MDOH), our Facility is required to update you weekly on all 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. 

 

Vaccine Updates:

 

On 4/18/23, the U.S. Food and Drug Administration (FDA) amended the emergency use authorizations (EUAs) of the Moderna and Pfizer-BioNTech COVID-19 Bivalent mRNA vaccines to simplify the vaccination schedule for most individuals. The monovalent Moderna and Pfizer COVID-19 vaccine are no longer authorized for use in the United States.

 

Recently, the CDC has recommended a secondary Bivalent Booster for anyone over the age of 65.  At this time, the facility is working on scheduling a vaccine clinic for all of our residents.  In the next few weeks, you will be contacted for consent to administer the recommended vaccine.  You will receive education related to the benefits and potential adverse effects of receiving the vaccine.  If you should have any questions after receiving the information, please do not hesitate to contact the facility for assistance. 

 

COVID OUTBREAK: 

 

  • Skilled Nursing: 142 total positive cases, 111 positive staff cases, and 31 resident cases since 5/4/22. Our last positive staff case was 5/2/23 and last positive resident case was 5/4/23. Exposure testing continues for staff and residents on 1st floor and masks are required to be worn by all staff and visitors entering 1st & 2nd floor skilled nursing.

 

  • Memory Care/Assisted Living: No positive cases since last week.

 

Our current rate of skilled resident vaccination is broken down in to fully vaccinated and up to date- 96% of our skilled nursing residents are fully vaccinated with 62% being up to date with the Bivalent Booster. Our current rate of fully vaccinated staff is 100% with 24% being up to date with the Bivalent Booster. 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).

 

Weekly Metrics used to Determine COVID 19 Community Level: This is the last week these metrics will be available from the CDC- they are doing away with this information on 5/11/23.

 

Data through May 4, 2023:

COMMUNITY TRANSMISSION:  Moderate

Case Rate per 100,000: 15.23

New COVID Admits per 100,000:  0.6

% Staffed In-Patient Beds in use by Patients with Confirmed COVID 19:  0.9%

The above information can be found at:  CDC COVID Data Tracker: County View

 

Testing:

We are only testing residents and staff who have been exposed to someone with covid or who are symptomatic.

 

Visitation:

Visitors are not required to be vaccinated to visit and they are not required to show proof of vaccination either. If you have been exposed to covid, we ask that you not visit at this time and test yourself.  Family members are permitted to attend activities with residents. If your loved one is on 1St or 2nd floor skilled nursing, we ask that you wear a mask while visiting until our outbreak is over.

 

Independent Living

 

  • 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.

 

Respectfully,

Angie Thompson, LPN/IP, Director of QA/IFC

Stephanie Young, LPN/IP

Leah Miller, GNA/IP

 

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

Mitigation Strategies

Reviewed 4/19/23

 

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 residents and families are able to visit and see each other during the current COVID-19 health crisis. Visitation by family and friends is critical to the quality of life of our resident population.

 

Visitation can be conducted through different means based on the facility structure and resident needs, such as resident rooms, dedicated visitation spaces and outdoor access.  Regardless of how visits are conducted, every visitor must abide by the Core Principles and best practices of Infection Control to reduce the risk of COVID-19 transmission. Those Core Principles are as follows:

  • Signage will be posted at visitor entrances detailing the recommended actions for visitors related to COVID-19 Infections.  This will include instructions for visitors who have a positive viral test for COVID-19 (Visitors with confirmed, COVID-19 infections or compatible symptoms of COVID-19, will be asked to defer non-urgent in-person visitation until they meet CDC criteria for healthcare settings to end isolation-10 days).  Or have had close contact with someone with COVID-19 (defer non-urgent in-person visitation until 10 days after their last close contact if they meet criteria described in CDC healthcare guidance).
  • Visitors will complete hand hygiene prior to visitation (ABHR is preferred).
  • Source Control (the use of PPE, including masks) protocols in accordance with CDC guidance.
  • Signage will be posted at visitor entrances throughout the facility on the signs and symptoms of COVID-19, infection control precautions, and other facility practices/protocols, such as entrances, exits, and routes to units. 
  • High-Touch surfaces in the facility are cleaned and disinfected often and designated visitor areas are cleaned and disinfected often as well.
  • Staff utilize appropriate PPE
  • Effective resident cohorting is utilized
  • Resident and staff testing is conducted as required by state and federal guidance.

 

 

The facility strongly encourages but does not require that visitors comply with testing.  The facility will request visitors to complete COVID-19 testing approximately 72 hours prior to visitation or the Facility will offer testing immediately prior to visit, especially when Community Transmission Rates are HIGH.

The facility does not require visitors to be vaccinated or show proof of vaccine in order to visit, but the facility does recommend that all visitors become vaccinated to help prevent the spread of COVID-19.   

If in HIGH Community Transmission Rates, all visitors must don/apply a well-fitting surgical mask upon entrance to the facility.  If a 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 and will post educational signage to encourage vaccination according to CDC guidelines. 

 

Procedure for Visitation:

 

The Facility will permit resident visitation under the following guidance: 

 

  1. Any visitor who cannot adhere to the core principles of Infection Prevention will not be permitted to visit and will be asked to leave promptly.
  2. The facility does not require but strenuously encourages all visitors to be tested for COVID 19 prior to their visit.  The facility will provide testing for all visitors.
  3. All visitors and residents must complete hand hygiene before and after all visits.  Alcohol-Based Hand Rubs are preferred.
  4. All visitors will screen at the reception desk prior to visitation.  Screen included assessment for signs and symptoms of COVID and potential exposure.
  5. Outdoor visitation is recommended.
  6. Indoor Visitation is allowed.  Frequency and length of visits are not limited.  The number of visitors is not limited either, but social distancing must be observed in large groups in a large area that can accommodate this measure. 
  7. If a resident chooses, when they and their visitors are alone in the resident room or designated visitation area, may choose not to wear masks and may choose to have close contact.  If a roommate is present, masks should remain in place.
  8. Residents who are in Transmission Based Precautions can still receive visitors.  All of these visits will be in the resident room.  The visitor will be made aware of the potential for exposure and precautions necessary to prevent infection.  The visitor will be provided appropriate PPE by the facility. 
  9. When Community Transmission Rates are high, all visitors will don and maintain source control when in the building.  

 

COMMUNAL ACTIVITIES, DINING and OUTINGS

  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 receive hand-hygiene before and after activities or dining.
  4. Residents will be asked to maintain social distancing during mealtimes and communal activities.
  5. Residents who are in Transmission Based Precautions will abstain from communal dining and communal activities until Transmission Based Precautions are discontinued.
  6. Any equipment used for communal activities will be disinfected before and after use.
  7. Dietary staff will sanitize tables before and after meals.
  8. Activities personnel will sanitize tables before and after activities. 
  9. Fully vaccinated volunteers will be permitted to volunteer their services.  They must provide documentation of their vaccination status.
  10. Outside Group Activities may be held.  The facility encourages every resident who participates to practice all steps of core principles of Infection Prevention at all times when on these outings into the greater community.

 

MITIGATION PROCEDURES

STAFF CONDUCT:

  1. 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. 
  2. Every time you enter the building, you must complete hand hygiene.  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 (Stephanie Young, Leah Miller, or Angie Thompson). If you do not screen, you may not enter the facility.
  3. Every time you enter the building, you must be screened at the established screening stations (auditorium, front desk)
  4. If you are sick, stay home.  Do not come to work sick. 
  5. Regardless of your vaccination status, you must report any of the following criteria to Infection Control without delay:
  • A positive viral test for SARS-CoV2
  • Symptoms of COVID-19
  • A high-risk exposure to someone with SARS-CoV2 Infection
  1. Any staff member who has or report symptoms of COVID-19, regardless of vaccine status, must be tested as soon as possible and are restricted from entering the facility until results are known and receive instruction from the IFC/IFP Department. If a staff member, declines to be tested, they will relieved of duties and not allowed to work until they comply with testing according to State and Federal requirements. 
  2. All staff must screen prior to start of work. Screening stations are located in the auditorium and reception.
  3. 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. Environmental Services will supply units with pump sprays of bleach solution daily or disinfectant wipes (EPA List N acceptable disinfectants only).  Once mixed, the bleach solution is only good for 24 hours.  Please use it to clean your workspace frequently.  Focus on High Touch Surface Areas.  Phones, doorknobs, handrails, med/treatment carts, tables, desks, and keyboards.  IT has provided screen wipes to be used on computer screens and cell phones.  Once applied, allow the area to air dry.  Disinfecting wipes will be utilized whenever possible. Stickers denoting kill times for product will be placed on the containers for a quick reference for staff to assure appropriate use.
  4. Practice Respiratory Etiquette.  If you need to cough or sneeze, please do so into a tissue, or elbow.  Wash your hands!!!!
  5. You must practice Social Distancing as your job allows.
  6. COVID testing of staff will be determined by Federal and State guidance.  
  7. 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. 
  8. Any contractor or non-staff clinician must be symptom-free upon entry to the facility. If exhibiting any symptom of SARS-CoV2, any contractor or non-staff clinician will refrain from entering the building until they are free of symptoms, or an alternative diagnosis of a noncontagious nature are made
  9. Staff will be updated weekly with new or changed mitigation interventions.   
  10. All medication carts will have a container of disinfecting wipes and a bottle of hand sanitizer.
  11. All vital signs machines will have a container of disinfecting wipes and bottle of hand sanitizer in basket.
  12. All Mechanical lifts will have a container of disinfecting wipes and bottle of hand sanitizer in their bag.  The lift will be disinfected each time after using it on a resident.
  13. Staff members are to report any HIGH-RISK exposure to any individual with a confirmed SARS-Cov2 infection. See Return to Work Criteria for HCP Who Were Exposed to Individuals with Confirmed SARS-CoV2 Infection of CDC’s Interim Guidance for Managing Healthcare Personnel with SARS-CoV2 Infection or Exposure to SARS-CoV2 for definitions of HIGH-RISK exposures. Once reported, staff will be expected to test immediately but not earlier than 24 hours after the exposure.  If negative, again after 48 hrs after 1st negative result, and if negative for 2nd test, then test again in 48 hours after 2nd test (a total of 3 tests).  If an asymptomatic staff person has recovered from SARS-CoV2 Infection within the previous 30 days of exposure, they should not be tested.  If exposure occurs on day 31 through 90, they should only be given an antigen test, do not test using NAAT. 

The exposed, asymptomatic staff members will wear well-fitting source control and monitor themselves for any symptom of SARS-CoV2.  They will not report for work if they have symptoms or test positive.

  1. Staff members with SARS-CoV2 infection will be managed according to CDC guidance as outlined in Interim Guidance for Managing Healthcare Personnel with SARS-CoV2 infection or Exposure to SARS-CoV2.
  2. 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.
  3. Nursing, Rehab, EVS, Activities and Maintenance will be required to complete Bi-Annually PPE Doffing and Donning Demonstration training with Director of Staff Development.  Also, all staff will have monthly refresher questionnaires to be completed.  All staff must comply, or corrective action will be taken.
  4. When Community Transmission Rates are HIGH, the staff will don and maintain source control while in the facility.

 

RESIDENT CONDUCT:

  1. All new admissions, readmissions and any resident who is out of the facility for more than 24 hours, will be tested upon admission, and if negative, again 48 hours after the first negative test, and if negative, again 48 hours after the 2nd negative test. They will also be asked to wear source control for 10 days following their admission or return to facility.  
  2. If a resident has had an exposure to a positive COVID-19 person, they will be placed in Source Control X10 days. They will receive testing as follows:  upon notification of exposure (needs to be at least 24 hours after exposure), if negative 48 hours after the initial negative test result.  If that test is negative, then again in 48 hours after the second negative result.  If all 3 tests result as negative, they can be removed from TBP-Source Control.  They will be asked to wear source control for 10 days following the exposure.
  3. Any resident who displays respiratory or gastrointestinal symptoms or any symptom of COVID 19, will have Transmission Based Precautions, Droplet/Contact initiated and remain until symptoms have resolved.
  4. 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. 
  5. Any resident with a significant change in condition must be seen by the clinician in a timely manner.  Either in person or via telehealth.
  6. Residents and their families or legal representatives will be updated weekly with facility status and new or changed mitigations interventions. 
  7. COVID testing of residents will be determined by Federal and State guidance.  
  8. If a Resident declines testing for COVID 19, they will be placed in Transmission Based Precautions, Source Control for 10 days or until they comply with recommended testing.
  9. If a Resident is transferred to another facility or hospital, the facility will alert the emergency services, transportation services and receiving facility of any suspected diagnosis, observation/quarantine, or confirmed COVID 19 and precautions to be taken by transferring and receiving staff as well as the source control required during the transfer.
  10. Any Resident who leaves the facility will be offered source control to don while they are out of the facility.
  11. When Community Transmission Rages are HIGH, residents are asked to don and maintain source control when out of their rooms.

 

Confirmed COVID Positive Resident Protocol:

  1. Residents with confirmed COVID Infection will be maintained or placed in a private, single-person room that does not share a bathroom.
  2. The door of the room will be kept closed (if safe to do so).
  3. If cohorting, only residents with the same infection/pathogen (if COVID infection, should be at or near the same stage of infection) should be housed in the same room. MDRO colonization status and/or presence of other communicable diseases should also be taken into consideration.
  4. If COVID infection rates are high (>10% of the resident population), the facility should consider a dedicated COVID Unit along with a dedicated staffing pattern.
  5. All care and services should be provided in the resident room.
  6. Residents will be placed in Transmission Based Precautions, Contact/Droplet.
  7. In-Person Visitation is discouraged during active infection, however, if both resident and visitor choose, visitation is allowed however, education will be given on other visitation methods, risks involved with an in-person visit, education on hand hygiene, limiting surface touches, and use of PPE according to facility protocols.
  8. Residents will remain in Transmission Based Precautions, Droplet/Contact, until they fit criteria established by the CDC for Duration of Transmission-Based Precauti9ons for Patients with SARS-CoV-2 Infection.