Whether it’s an extended first wave or the cresting second wave that is now consuming the nation, there’s no doubt that case numbers are continuing to rise.1 This is especially concerning for skilled nursing facilities (SNFs) since data collected during the pandemic makes it clear that mortality rates in care facilities are higher than state-level averages.2
As a result, SNFs are well-served tackling the task of proactive emergency preparation ASAP to ensure processes, people and prevention measures are in place to meet the challenges being faced right now. Here are a few suggestions we’ve assembled based on best practices we’ve observed with our clients.
Establish Organizational Frameworks
According to the Centers for Disease Control and Prevention (CDC), “nursing home populations are at high risk of being affected by respiratory pathogens like COVID-19 and other pathogens.”3 As a result, the agency recommends the development of strong infection control programs (ICPs) to protect both residents and healthcare workers to help limit the spread.
The CDC specifically calls out the assignment of dedicated personnel to manage these on-site efforts, but frameworks may also include organizational tools such as SNF-specific software solutions that help personnel better manage facility-wide patient data. The CDC also recommends competency-based training of all healthcare personnel (HCP) to ensure they have the most up-to-date IPC knowledge and skills available.4
The COVID Infection Prevention Plan for SNFs
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Refine Testing Strategies
Testing is also critical for SNFs to effectively manage the second COVID wave. The CDC suggests initial, facility-wide testing to identify Coronavirus cases or clusters, followed by serial testing to help define cohorts and identify the origin of new cases to limit overall spread.5
In addition, the CDC recommends strategies for SNFs that include:
- A plan to move COVID-positive residents to other facilities, if possible. Digital facility management tools may help streamline this process with data about available beds.6
- Procedures to exclude COVID-positive SNF employees from work along with return-to-work processes. Real-time scheduling software and applications may assist with this effort.7
- Daily testing of residents for fever along with self-reporting of any COVID-19 symptoms. Here, unified reporting procedures can help reduce the risk of missed daily assessments.8
Communicate Control Measures
Along with organizational frameworks and testing strategies, the CDC also points to source control measures as a way to limit the spread of second-wave COVID infections in SNFs.9 Specifically, the agency recommends that healthcare personnel wear facemasks — rather than cloth face coverings — at all times while in the facility. Residents, meanwhile, should wear masks whenever they leave their rooms, regardless of whether they remain in the facility or are leaving for outside medical appointments.
SNFs must also consider the role of source control measures to help reduce the risk of external COVID transmission via approved visitors. While the CDC recommends that all visitors wear masks at all times, the agency also encourages SNFs to develop and communicate plans for visitor restrictions depending on the spread and severity of COVID-19 cases. Potential approaches include:
- Sending letters or emails to residents’ families reiterating the need to stay home when sick or if they have any known exposure to COVID-19 positive individuals.10
- Implementing technologies such as video- or teleconferencing to facilitate socially distant visitations.11
- Posting clear signage at all entry points about facility expectations, such as the need for facemasks and symptom assessment from staff prior to visiting residents.12
- Defining thresholds at which restrictions will change — such as a specific number of cases or the severity of case outcomes — and communicating these changes to residents’ families.13
Skilled nursing facilities face new challenges as COVID waves continue to ebb and flow. And while perfect infection control is impossible, proactive preparation of organizational frameworks, testing strategies and control measures can help improve SNF response.
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Resources
1Time, “The Third Wave of COVID-19 in the U.S. Is Officially Worse Than the First Two,” October 25, 2020.
2CDC, “Covid-19 Science Update,” October 2, 2020.
3-4CDC, “Preparing for COVID-19 in Nursing Homes,” June 25, 2020.
5-7CDC, “Performing Facility-wide SARS-COV-2 Testing in Nursing Homes,” May 19, 2020.
8CDC, “Testing Guidelines for Nursing Homes,” October 16, 2020.
9-13CDC, “Preparing for COVID-19 in Nursing Homes,” June 25, 2020.