· Infection Control: Outbreak Plan ·

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Policy:

It is the policy of Rose Garden Nursing and Rehabilitation Center to have an infection prevention plan that: Identifies the spread of facility infections, Measures to isolate and contain the spread of infection, Reports to appropriate agencies in the event an infectious outbreak occurs. 

 

Procedure: 

Background Reference: 

 

  • Known infections or residents with s/s of infection are identified via: direct observation, vitals, labs, radiology, resident assessment, resident communication, family assessment of resident condition. 

 

  • All residents who have community based infections upon admission at Rose Garden are treated from the time of admission for the infection as per physician orders, monitoring orders, isolation orders ( if applicable). 

 

  • Residents who develop signs or symptoms of infection will be reported to the physician for further instructions regarding orders for monitoring, labs, radiology. 

 

  • Regardless of the origin of the infection, communication is provided to direct care staff, the resident representative, physician and other departments who may come in contact with the resident. Communication to staff is done: verbally, via 24 hour report, triage report, isolation signage for the resident room, isolation icon on EMR. Other departments are informed via: signage on resident rooms and daily morning report. 

 

  • Standard precautions adhered to unless transmission based protocol is warranted

 

An outbreak is defined as any infectious event that is above the usual baseline established by historical infection control rates for the facility.  An outbreak may be a cluster of residents who share similar signs and symptoms that are above baseline. An outbreak may also be a singular event affecting 1 person that poses a physical threat of spread of the infection to others. 

 

In the event of an outbreak the Director of Nursing, Infection Preventionist and Medical Director will take the lead in collecting and analyzing data. All departments will be notified that an outbreak has occurred and measures to control the outbreak will be developed in a rapid manner.  Resident safety measures taken to mitigate spread may include but are not limited to:

 

  • Isolation: Maintaining care to the resident in the comfort of their room until they are asymptomatic and the duration of the incubation period is complete
  • Cohorting residents by diagnosis and/or symptoms
  • Daily monitoring of resident condition as per facility protocol
  • Staff education; hand hygiene, PPE, standard infection control guidelines
  • Housekeeping intervention to target identified areas ( clusters) of infection for deep daily cleaning in rooms and common areas
  • Adherence to physician orders regarding medications, labs and radiology for those affected and those potentially exposed
  • Daily line list and IDT meetings for close monitoring and communication
  • Continuity of staff; avoidance of floor rotation; dedicated staff
  • Closing of common areas or restrictions to large common areas 
  • Disposable food delivery if applicable 
  • Providing room activities 

 

Quarantine Guidelines

Should an outbreak occur that is highly contagious and poses a direct threat of transmission to others the facility may make the decision to go into quarantine until the threat has ended. The decision to go into quarantine is made with the guidance of the Ocean County Board of Health and Department of Health.  

 

In the event of a quarantine, the facility shall publicly post in the front lobby quarantine procedures and the reason for the quarantine.  Family members, visitors, vendors, contractors and all others will be strongly advised to defer from visitation until the quarantine is lifted. If dictated by the OCBOH or NJDOH the facility will totally restrict visitors, vendors and non-essential personnel. 

 

  • Resident representatives shall also be notified via Voice Friend of the quarantine. 
  • All common areas affected by the quarantine will be temporarily closed. 
  • All activities in common areas affected by the quarantine will be temporarily suspended. Room visits will be provided if requested or assessed to be needed. 
  • Measures stated above to prevent the spread of infectious organisms will be implemented. 

 

The Infection Preventionist, Director of Nursing and Medical Director will oversee adherence to quarantine guidelines and will work the the Ocean County Board of Health, Department of Health and any other agency required to manage the care and appropriate medical interventions to care for those afflicted and prevent the spread to others who may have been exposed. 

 

Covid-19 Specific Outbreak Policy

 

Summary of Lessons Learned:

In March 2020 NJ experienced an outbreak of the novel Coronavirus (aka Covid-19) which swept through long term care facilities causing mass illness and death. While Federal and State agencies scrambled to provide guidance and assistance the virus was already present in most NJ facilities. Initial blunders in both State and Federal directives have for the most part been corrected, but more is needed to prevent a second wave of infection. To date there is not a universal nationwide policy to prevent the spread of Covid-19 and unfortunately a worldwide pandemic has been politicized to the detriment of those of us on the front line. 

 

On the part of Rose Garden; we have consistently followed directives from Federal and State agencies to prevent the entry and transmission of Covid-19. We welcome new guidance as more is learned about the virus from scientific experts and our administrative staff is engaged in continued education. 

 

 The primary components that have proved an effective means of preventing the entry and spread of the virus are: Testing, cohorting, PPE,  enhanced environmental cleaning and staff/resident/family education. As we move forward there are still challenges that face long term care facilities. National testing labs that are overtaxed can be delayed in processing resident/employee Covid tests. Also, PPE is still an issue as it is scarce and outside vendors have inflated their prices by over 1000% which makes purchasing

cost- prohibitive or unobtainable in many cases. Despite laws that prevent price gouging we are subject to price gouging with all of our PPE supplies as are our neighboring facilities. Nevertheless, we press on  with the resources that we have been able to obtain and look forward to the time when both the State and Federal government will give long term care facilities the same support and resources that have been shown to our hospitals.  

 

The information below are the current procedures that we have in place.

 

Employee/Vendor/Visitor Screening

  1. All employees/essential vendors/visitors are screened as per NJDOH/CDC/CMS guidelines prior to entering the facility. Initial screening is done prior to employees entering the facility.  
  2. Temperature checks are done upon entry and exit of all employees/visitors/essential vendors. 
  3. Employees/visitors/essential vendors who do not pass the initial screening are not permitted into the facility. 
  4. Visual aides for screening and education are provided both inside and outside of the facility. 

 

Cohorting

  1. Residents will be cohorted by wing/designated area based on symptoms and testing
    1. Ill wing – Residents who have tested +
    2. Exposed wing- New admissions or residents who have been potentially exposed
    3. Well wing – Residents who have tested negative and are asymptomatic with no/low risk of exposure

 

Testing 

*All residents and staff are tested weekly as of May 2020

  1. All residents and staff who are negative will be tested weekly thereafter. 
  2. Employees who test + will be prohibited from work for a minimum of 10 days of no symptoms/3 days of no fever without use of fever-reducing medication and 2 negative Covid tests.
  3. All new admissions are requested to be tested for Covid prior to admission
  4. All new admissions who have tested negative for Covid-19 will be placed on an “exposed” wing with transmission based precautions for a minimum of 14 days
  5. Residents who test + for covid will be transferred to the “ill” unit OR will be treated in place if there are multiple residents on 1 wing who test positive. 
  6. All residents who test + for covid will be kept on Enhanced transmission Covid isolation for a minimum of 14 days and have 2 negative covid tests.
  7. Staff members provide verbal consent for testing/results at the point of testing. Staff members who receive off-site testing voluntarily provide their test results. The facility does not call private/public labs to obtain results. 
  8. Staff members who test positive for COVID-19 , refuse testing or who choose to  not provide testing results to the facility are excluded from work. 
  9. Return to work protocol: Staff members who test positive for COVID-19 must provide 2 negative test results before resuming their position at the facility. 
  10. Contingency staffing plans are in place and located in the facility assessment. 

 

PPE

Admissions/Readmissions:  

All admissions/readmissions will be assigned to the exposed wing and kept on transmission precautions for 14 days. Full PPE is provided and is to be donned/doffed per resident on the exposed wing. 

 

Covid -19 Units:

Dedicated PPE is provided to any team member entering the Covid isolation units.  Team members exiting the isolation units doff their PPE and perform all appropriate infection control measures such as hand hygiene prior to leaving the unit . Disposable PPE is discarded in isolation trash bins. Washable PPE is placed in an isolation linen bin. 

 

PPE:

  • Isolation PPE:  Face shield/goggles, N-95s, washable gowns and gloves
  • Dedicated Use/Reusable: Goggles/ face shields, N-95s, cloth gowns
  • Discard: Plastic gowns, hair caps and gloves in isolation disposal cart
  • Hair covering caps are also available for team members and encouraged

N95s:

  •  N95s are to be used at all times. The supply of N95s are universal size. Seal checks by the employee are done at the time of issuance. 
  • N95s are issued upon hire and are disinfected q5days. A new N95 mask is issued at the time of disinfection. The disinfected N95 will be returned to the team member in a clean paper bag for storage. In 5 days that mask can be used as the current mask is disinfected. 
  • Masks that are broken, visibly soiled or otherwise unusable will be replaced
  • Team members are permitted to wear surgical masks in addition to N95 as per their personal preference. Surgical masks are disposable and are not subject to disinfection. 

Face Shields:

  • Goggles/face shields are distributed to all direct care workers 
  • Goggles/face shields are disinfected with FDA approved cleaner when visibly soiled
  • Goggles/face shields are available to ALL staff members and are replaced if broken or unusable for any reason

Gowns:

  • Washable gowns are available to all direct care staff providing care to residents on isolation precautions

 

Instructions for Obtaining needed PPE

  • N95s and face shields/goggles have been distributed to all direct care staff and are supplied to any new employee from Central Supply
  • Gowns and gloves are provided in bins outside each isolation room
    • For ill wings, washable cloth gowns are provided. They can be used throughout the shift only on the ill wing.  Gowns that are soiled are to be placed in an isolation bin for cleaning and a new gown donned
    • Exposed wing: Cloth gowns are changed before/after care for each resident. 
      • As a backup to cloth gown use, Johnny coats/ disposable arm sleeves are a permissible alternative.
    • Johnny coats are to be placed in isolation bin for washing
    • Disposable arm sleeves are to be discarded in isolation trash bin

In the unlikely event that Johnny coats or cloth gowns are being laundered and are not available a plastic poncho WITH arm sleeves may be used. Ponchos are available in central supply if needed.

 

Source Contact:

Surgical Masks/face covering provided to residents ( if tolerated) during direct care. 

 

Resident Mask Use:

Residents who leave their room are encouraged to use a mask or face covering. 

  • Masks are donned by residents who are being transferred to/from the facility
  • Masks are donned by residents whenever they are accompanied by staff to any part of the facility

 

Communication to Families:

Family communication is provided weekly via Voice Friend which is an email listserv communication software service. Families are notified by 5pm the next calendar day if there is a single confirmed infection of Covid-19 or whenever three or more residents or staff with new-onset respiratory symptoms occur within 72 hours of each other. 

 

Communication to Residents:

Residents receive written communication if there is a single confirmed infection of Covid-19 or whenever three or more residents or staff with new-onset respiratory symptoms occur within 72 hours of each other. Written communication is also provided for any change in facility policy related to the current Covid-19 restrictions. Additionally, residents are provided with verbal daily and/or weekly updates from their social worker. 

 

Virtual Visitation: 

Rose Garden provides virtual communication via phone, video-communication ( Facetime, Skype)  and traditional mail. The Virtual Visitation Coordinator is the Social Service Directors who schedule virtual communication visits. Virtual visits are scheduled daily. 

 

Outdoor Visitation: 

Policy:

Rose Garden Nursing and Rehabilitation Center in compliance with NJDOH Executive Directive No. 20-017 issued 6/19/202 ( replacing guidance issued 3/15/2020) directs: 

 

“Designated Outdoor Visitation Space by appointment only. Beginning on June 21, 2020, facilities may allow in-person visitation in a designated outdoor visitation space, provided that the facility implements all of the following safety, care, and infection prevention and control measures:

 

  • a) Facilities may start scheduling appointments on the effective date of this Executive Directive, but visitation may not begin until June 21, 2020. 
  • b) A resident who is suspected or confirmed to be infected with COVID-19; or quarantined for an exposure to a COVID-19 case cannot be visited except for an end of life situation. A resident who has been diagnosed with COVID-19 may be visited only after they have met the criteria for discontinuation of isolation as defined in guidance from NJDOH and CDC. 
  • c) The facility should honor each resident’s right to have and choose visitors and to make preferences. The facility should consult every resident to determine who the resident would wish to visit with in person. These consultations also serve as a personalized communication with the resident to explain how visitation will work and what the resident can expect.
  • d) Clear communication of the visitation policy should be provided to residents, resident’s visitors, staff and others, as needed in writing, via the methods the facility uses to convey information or policy changes. Facilities should consider providing the visitation guidelines in various languages as needed. 
  • e) The facility should establish a designated area for visitors to be screened that accommodates social distancing and infection control standards. Visitors should be provided with the visitation guidelines upon check in. The facility should provide graphics to assist residents and visitors in maintaining social distancing and infection control standards. Visitors are not permitted entrance past the reception area of the facility, including restrooms, which will not be available to visitors at this time.
  • f) The facility should provide a visiting area with accommodations offered for those with mobility needs and designated seating for visitors. The facility should also provide reasonable accommodations for any resident with a disability, such as hearing, vision, or cognitive impairments, and assist any resident with transport using their adaptive equipment. 
  • g) Prior to transporting a resident to the designated outdoor visitation space, the long-term care facility must screen the visitor for infectious communicable diseases, including COVID-19 symptoms. Any visitors with symptoms of COVID-19 infection (subjective or objective fever equal to or greater than 100.4 F or as further restricted by facility policy, chills, cough, shortness of breath or difficulty breathing, sore throat, fatigue, muscle or body aches, headache, new loss of taste or smell, congestion or runny nose, nausea or vomiting, or diarrhea) will not be permitted to visit with a resident.
  • h) Transport of a resident to and from the designated outdoor visitation space must be safe and orderly. At a minimum, safe transport means that the resident cannot be transported through any space designated as COVID-19 care space or space where residents suspected or confirmed to be infected with COVID-19 are present. Transport must be done while keeping 6 feet distance between other residents and staff. 
  • i) A long-term care facility staff member familiar with the required protocols must remain with the resident at all times during the visit.
  • j) Each resident is limited to no more than two visitors at a time. A visitor must remain at least 6 feet from the resident and attending staff member(s) at all times during the visit. Whenever possible, visitors should 6 wait in a vehicle prior to the visitation time. If the visitor is using public or ride share transport, the visitor(s) should wait in an outdoor space that ensures social distancing of at least six feet from other visitors.
  • k) Staff must wear a surgical facemask; residents must wear a face covering (surgical mask if supply is available); and visitors must wear a face covering or mask for the duration of the visit. Visits with a resident in a designated outdoor space must be scheduled in advance and are dependent on permissible weather conditions, availability of outdoor space, and sufficient staffing at the facility to meet resident care needs, as well as the health and well-being of the resident. Facilities should provide appropriate protection from the weather, (e.g. sun, heat, and rain). Visits may be cancelled because of inclement or unsafe weather conditions (e.g. high humidity/heat, poor air quality). 
  • l) A long-term care facility may limit the length of any visit, the days on which visits will be permitted, the hours during a day when visits will be permitted, and the number of times during a day or week a resident may be visited. 
  • m) Food is not permitted during the visits. Visitors may bring items for the resident but must leave the package at reception or another location, as directed by the facility. Visitors may bring their own water which cannot be shared with the resident. The facility shall provide appropriate hydration for the resident during the visit. 
  • n) At the conclusion of the visit, the residents should be transported back totheir rooms by a facility staff member. 
  • o) The facility must receive informed consent from the visitor and the resident in writing that they are aware of the possible dangers of exposure to COVID-19 for both the resident and the visitor and that they will follow the rules set by the facility in regard to outdoor visitation. The facility must receive a signed statement from each visitor and resident (if the resident is unable to consent then the consent needs to be signed by the authorized representative) with a copy provided to the visitor and resident, that they are aware of the risk of exposure to COVID-19 during the visit, that they will strictly comply with the facility policies during outdoor visitation, and that the visitor will notify the facility if they test positive for COVID-19 or exhibit symptoms of COVID-19 within fourteen days of the visit.” 

 

Rose Garden’s Procedure for Outdoor Visitation

 

  1. Scheduling Appointments for Visitation

    1. Please call Rose Garden at 732-505-4477 and inform the front desk receptionist that you would like to schedule a visit. The receptionist will take your name/number and date/time of preference for a visit. 
    2. This information will be provided to the activity department who will call you back in a timely manner to confirm your visit. 
  2. COVID-19 Residents/Exposed; Visitation Restrictions

    1. Residents who reside on the COVID-19 wing will not be able to participate in the outdoor visits. 
      1. Visits will be permitted after two negative test results are obtained
    2. Residents who reside on the exposed wing will not be able to participate in the outdoor visits
      1. Visits will be permitted after 14 days and two negative test results
  3. Resident Preference

    1. Residents retain the right to accept or decline an outdoor visit from family/friends
  4. Communication

    1. Residents – Residents were notified on 6/19 via written notice regarding outdoor visits
    2. Families – Families were notified on 6/19 via email regarding outdoor visits
    3. Staff – Staff were notified on 6/19 via email and internal messaging regarding outdoor visits
  5. Visitor Screening

    1. Visitor screening will be in the front entrance vestibule. A walkie talkie is provided that connects you directly to the receptionist.  Each member of the visiting party will be asked a series of COVID-19 screening questions prior to the visitation. 
    2. Visitors will NOT be permitted past the front vestibule and will not enter the facility. 
    3. Restrooms will not be able to be provided for visitors
  6. Visiting Area Accommodations

    1. Outdoor visits will take place in the facility courtyard
    2. Chairs will be provided for visitors
    3. The courtyard is wheelchair accessible
      1. If a visitor requires special accommodation or assistance please inform the front desk or activity personnel prior to your visit
  7. Health Screening of Visitors

    1. There is a poster in the vestibule area that lists the symptoms that you will be asked during the health screening
      1. The poster is displayed in both English and Spanish
    2. The receptionist will also ask you additional questions related to your exposure to the COVID-19 virus
    3. ANY visitor who does not pass the health screening will not be able to proceed with the visit
  8. Transporting residents to the visitation area

    1. Residents will be brought to the courtyard area while maintaining social distancing from other residents
    2. Residents will not be transported through any wing that has exposed or COVID+ residents
  9. Staff Supervision

    1. A staff member will be present throughout the duration of the visit to ensure compliance with face coverings and social distancing
  10. Number of Visitors Allowed

    1. A maximum of 2 visitors at a time is permitted as per DOH guidelines
    2. A six foot buffet table will be used as a social distancing buffer between you and your loved one.  
      1. Visitors will be seated at one end of the buffet table 
      2. Residents will be seated at the opposite end
      3. At no time are you permitted to breach the 6 foot barrier
    3. If you arrive early and have already completed your health screening please wait in your car until it is time for your visit
      1. Please allow other family members to leave the courtyard area before proceeding to your visit. We must maintain at least a 6 foot distance between visitors
    4. Visitors who do not have a vehicle may wait in seating provided in front of the building with 6 foot distancing
  11. Mask Use/Weather Conditions

    1. Mask use MUST be in place for all parties
      1. Resident will be wearing a mask/face covering
      2. Visitor needs to be wearing a mask/face covering
      3. Staffing attendant will be wearing a mask
    2. All visitation is contingent on weather conditions. 
      1. Rose Garden reserves the right to cancel visits due to inclement weather including but not limited to high heat index/humidity
    3. Rose Garden will provide pop up canopies for shelter/comfort during visits
  12. Visitation Days/Times

    1. Visits are scheduled 7 days per week from the hours of 1pm-5pm
      1. 4:30 is the last scheduled visit of the day
    2. There is no limit on how many times you can visit a loved one during a day or week pending availability
    3.  Social distancing of a minimum of 6’ must be maintained at all times
  13. Food

    1. The DOH has determined that food may not be brought to a family visit
    2. Visitors are permitted to bring water for their personal use
    3. Residents will be provided hydration throughout the visit
  14. Resident transport at the end of the visit

    1. Activity and/or nursing staff will assist residents back to their room after the visit
  15. Informed Consent for the visit

    1. After a visitor has passed the health screening you will be provided with an informed consent form for your signature for the visit/potential risk of visitation and an acknowledgment of rules during the visit.
    2. Visitors agree to inform the facility if they develop any signs/symptoms of COVID-19 within 14 days of their visit
    3. Residents will also be presented with a signed consent form regarding the same. 
      1. If a resident is unable to sign the consent the responsible party must sign prior to the visit
    4. Consent forms will be kept on file for future visits
    5. Copies of consent forms will be provided to both the visitor and resident

 

All visitors are anticipated to comply with the above guidelines for outdoor visitation. If any visitor deviates from the above guidelines the visit will unfortunately have to end and that visitor will be subject to potential future restriction. 

 

The executive directive No. 20-017 further mandated that the facility attests to the NJDOH that they will abide by the above directive at least 24 hours prior to 6/21.  The facility attestation was completed and submitted on 6/19. 

 

These guidelines are current as of 6/19 and are subject to change. 

 

Staffing Contingency Plan:

In the event that an outbreak occurs at Rose Garden that has a direct impact on staffing the following actions will be taken:

 

  1. Incident Command set up to insure coordination between departments
    1. Set up means of communication for Dept heads, staff, families, residents, Medical Director, facility physicians, essential vendors
      1. Group text
      2. Conference calls
      3. Email chains
      4. Voice Friend
      5. Face to face verbal communication
  2. Triage resident care needs
    1. Staffing requirements
      1. Nursing- In the event of a catastrophic nursing shortage all restorative staff, administrative nurses, activity personnel who are CNAs/HHAs will be assigned on the floor
      2. CMS/DOH waivers: In the event of an emergency that warrants staffing waivers such as in the case of Covid-19 vigorous recruitment efforts via employment websites and social media will offer employment opportunities within the guidelines of such stated waivers. 
        1. Covid-19: Recruitment of TNAs as per waiver
        2. Covid-19: Recruitment of HHAs as per waiver
    2. Medication Reduction
      1. Attempt to reduce non-essential medications and txs to provide more direct nursing care
    3. Equipment Requirements
    4. PPE Requirements
      1. Burn rate calculator use by purchasing agent
  3. Guidance and Education
    1. Team members will participate in educational briefings from regulatory agencies such as : COCA calls, DOH briefings, CMS briefings. The assistant administrator will coordinate the team to ensure that timely information is available.  Policies will be adjusted as guidance dictates. 

     

 

 Emergency Staffing Minimum ( based on census of 120)

 

Nursing Day Shift 

First Floor LTC Second Floor  Sub Acute Unit 
2 Nurses 3 Nurses  1 Nurse
3 CNA 6 CNA 1 CNA

 

Nursing Evening Shift 

First Floor Second Floor Sub Acute Unit
1 Nurse  1 Nurses  1 Nurse 
3 CNAs  6 CNAS  1 CNA 
AVG Daily census: 36 AVG Daily Census: 59 AVG Daily Census: 20

 

Nursing Night Shift 

First Floor Second Floor Sub Acute Unit
Supervisor **** ****
*** *** ***
2 CNAs  3 CNAs  1 CNA

 

Administrative Nurses:

 In the event of an emergency Administrative nurses may be called on to provide direct resident care

  • Director of Nursing
  • Clinical Care Coordinator 
  • MDS Coordinator
  • MDS Med A nurse
  • Restorative Director RN
  • Nurse Practitioner for Optum residents 

 

Restorative Nursing:

In the event of an emergency restorative staff may be called on to provide direct care 

Restorative Nsg Sub-Acute First Floor Second Floor
RN Dept Head 1 1 1
CNA Rest Aide 2
HHA Rest Aide 1 1

 

Staffing Plan – Dietary

 

Dietitian 1
Cooks 2
Prep Cooks  1
Potwasher 2
Dietary Aides 3

 

Staffing Plan- Activities

 

First Floor  1
Second Floor 1
Room Visits 1

 

Housekeeping Staffing Plan

 

Housekeepers 1st floor 2
Housekeepers 2nd floor 2
Porter 1st floor 1
Porter 2nd floor 1
Evening Porter  1
Laundry day/evening 2
Personal clothing 1

 

Maintenance Staffing Plan

 

Maintenance Staff 1

 

Social Services Staffing Plan

 

Social Worker 1

 

Therapy Staffing Plan

 

PT 1
OT 1
SLP 1

 

Administrative Staffing:

All administrative staff necessary for the essential functioning of the facility will remain actively working on or off site. 

 

Administrator 1
Assistant Administrator 1
Comptroller 1
Admissions Director 1
Human Resources Director 1
Medical Records 1
Staffing Coordinator 1
Front Desk/ Receptionist 8a-8p 3 FT/ 2 PT 
Business Office Assistant 1
Nursing Station desk clerk 2

 

**CDC Guidance -Crisis Capacity Strategies to Mitigate Staffing Shortages

When staffing shortages are occurring, healthcare facilities and employers (in collaboration with human resources and occupational health services) may need to implement crisis capacity strategies to continue to provide patient care.

When there are no longer enough staff to provide safe patient care:

  • Implement regional plans to transfer patients with COVID-19 to designated healthcare facilities, or alternate care sites with adequate staffing
    • Rose Garden has an agreement with Sycamore in East Hanover for the transfer of residents in the event that transfer is necessary
  • If not already done, allow asymptomatic HCP who have had an unprotected exposure to SARS-CoV-2 but are not known to be infected to continue to work.
    • These HCP should still report temperature and absence of symptoms each day before starting work. These HCP should wear a facemask (for source control) while at work for 14 days after the exposure event. A face mask instead of a cloth face covering should be used by these HCP for source control during this time period while in the facility. After this time period, these HCP should revert to their facility policy regarding universal source control during the pandemic.
      • A facemask for source control does not replace the need to wear an N95 or higher-level respirator (or other PPE) when indicated, including for the care of patients with suspected or confirmed COVID-19
      • Of note, N95 or other respirators with an exhaust valve might not provide source control.
    • If HCP develop even mild symptoms consistent with COVID-19, they must cease patient care activities and notify their supervisor or occupational health services prior to leaving work. These individuals should be prioritized for testing.
    • If HCP are tested and found to be infected with SARS-CoV-2, they should be excluded from work until they meet all Return to Work Criteria (unless they are allowed to work as described below).
  • If shortages continue despite other mitigation strategies, consider implementing criteria to allow HCP with suspected or confirmed COVID-19 who are well enough to work but have not met all Return to Work Criteria to work. If HCP are allowed to work before meeting all criteria, they should be restricted from contact with severely immunocompromised patients (e.g., transplant, hematology-oncology) and facilities should consider prioritizing their duties in the following order:
    • If not already done, allow HCP with suspected or confirmed COVID-19 to perform job duties where they do not interact with others (e.g., patients or other HCP), such as in telemedicine services.
    • Allow HCP with confirmed COVID-19 to provide direct care only for patients with confirmed COVID-19, preferably in a cohort setting.
    • Allow HCP with confirmed COVID-19 to provide direct care for patients with suspected COVID-19.
    • As a last resort, allow HCP with confirmed COVID-19 to provide direct care for patients without suspected or confirmed COVID-19.
  • If HCP are permitted to return to work before meeting all Return to Work Criteria, they should still adhere to all Return to Work Practices and Work Restrictions recommendations described in that guidance. These include:
    • Wear a facemask for source control at all times while in the healthcare facility until they meet the full Return to Work Criteria and all symptoms are completely resolved or at baseline. A facemask instead of a cloth face covering should be used by these HCP for source control during this time period while in the facility. After this time period, these HCP should revert to their facility policy regarding universal source control during the pandemic.
      • A facemask for source control does not replace the need to wear an N95 or higher-level respirator (or other PPE) when indicated, including when caring for patients with suspected or confirmed COVID-19.
      • Of note, N95 or other respirators with an exhaust valve might not provide source control.
    • They should be reminded that in addition to potentially exposing patients, they could also expose their co-workers.
      • Facemasks should be worn even when they are in non-patient care areas such as breakrooms.
      • If they must remove their facemask, for example, in order to eat or drink, they should separate themselves from others.
    • Being restricted from contact with severely immunocompromised patients (e.g., transplant, hematology-oncology) until the full Return to Work Criteria have been met.
    • Self-monitoring for symptoms and seeking re-evaluation from occupational health if respiratory symptoms recur or worsen.

 

Updated August 12, 2020