-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Publication
A peer reviewed publication.
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
Free online on Lancet site.
URL
https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30560-0/fulltext
Read Online
Online location of the resource.
https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30560-0/fulltext
Citation
Citation information for the publication itself.
Hoxha, Ana, Chloe Wyndham-Thomas, Sofieke Klamer, Dominique Dubourg, Melissa Vermeulen, Naima Hammami, and Laura Cornelissen. 2020. "Asymptomatic SARS-CoV-2 infection in Belgian long-term care facilities." The Lancet Infectious Diseases.
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Asymptomatic SARS-CoV-2 infection in Belgian long-term care facilities
Subject
The topic of the resource
Treatment & Care
Description
An account of the resource
As of July 1, Belgium has 61 509 confirmed cases of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and 9754 related deaths. In early April, the ministry of health decided to implement a mass testing campaign in long-term care facilities (LTCFs; appendix p 1).
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-07-03
Type
The nature or genre of the resource
Publication
Creator
An entity primarily responsible for making the resource
Hoxha, Ana, Chloe Wyndham-Thomas, Sofieke Klamer, Dominique Dubourg, Melissa Vermeulen, Naima Hammami, and Laura Cornelissen.
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-01-01
2019-nCoV
Airborne Transmission
Coronavirus
COVID-19
Droplet Transmission
Long-term Care
R-LTC
-
https://repository.netecweb.org/files/original/e4fe4751d05fef9fb6a0a45a1ad12079.pdf
2aea531b96feaf15e58d20ac354a461c
PDF Text
Text
Consideraciones al limpiar
residencias de vivienda asistida
Por ser hogares al mismo tiempo que instalaciones de cuidado, existen
algunos desafíos especiales para limpiarlas y desinfectarlas:
• Alfombra, cortinas y decoraciones en las habitaciones
• Carros de tratamiento móviles y de medicamentos
• Comedor compartido
• Regulaciones diferentes a las de cuidados intensivos
Al igual que en cualquier entorno de atención, los residentes deben ser tratados
de una manera que mantenga o mejore su dignidad y respete su individualidad.
Esto significa:
• Respetar la privacidad y las pertenencias de los residentes
Toca la puerta y pide permiso para entrar (espera para la respuesta).
Pide permiso para examinar y limpiar las pertenencias del o de la residente.
No mueva cosas (si lo mueve para limpiar, vuelva a ponerlo em su lugar
original).
No mire a través de cajones o armarios.
No cambie de canal de televisión o de estación de radio.
• No publique ni comparte informaciones clínicas y
personales que sean confidenciales.
• Limpie y desinfecte según el horario del o de la residente,
no el suyo.
08-24-20
�
Guide
Document providing operation or response information, general guidance documents.
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Consideraciones al limpiar residencias de vivienda asistida
Subject
The topic of the resource
Elementos en Español
Description
An account of the resource
Spanish language version of <a href="https://repository.netecweb.org/items/show/1308" target="_blank" rel="noreferrer noopener">Considerations When Cleaning Assisted Living Facilities</a> printable flyer infographic.
Creator
An entity primarily responsible for making the resource
NETEC
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-08-24
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-01-01
2019-nCoV
Confidentiality
Coronavirus
COVID-19
Disinfection
Environmental Services
Español
Long-term Care
R-LTC
Spanish
-
https://repository.netecweb.org/files/original/27e415570daadb54229d4fd7134ef784.pdf
97beba387dd2fe66c2f03fca7c47bb35
PDF Text
Text
08-24-20
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Deploy
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Guide
Document providing operation or response information, general guidance documents.
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Considerations When Cleaning Assisted Living Facilities
Subject
The topic of the resource
Infection Control
Description
An account of the resource
This is a printable flyer infographic with information on considerations when cleaning assisted living facilities.
Creator
An entity primarily responsible for making the resource
NETEC
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-08-24
Contributor
An entity responsible for making contributions to the resource
2022-12-07 general asset review - IPC (LTC not IPC - move to T&C)
2024-03-28 by J. Mundy – IPC review 2023 (Q2) skipped – bumping to 2024 (Q2)
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-12-10
Identifier
An unambiguous reference to the resource within a given context
Adult Care
2019-nCoV
Confidentiality
Coronavirus
COVID-19
Disinfection
Environmental Services
Long-term Care
R-IPC
R-LTC
-
https://repository.netecweb.org/files/original/eebe5fb85e0fb6edda4dfa0d1e7e89ad.pdf
6ecb08af8d1c7aa902ecbd1b68d58dda
PDF Text
Text
Controles de ingeniería para cuidados a largo plazo
Se pueden implementar controles de ingeniería para aislar a las personas de un peligro y brindar
protección a los residentes y al personal de cuidados a largo plazo.
Eliminación
Sustitución
controles de ingeniería
Controles administrativos
EPP
+ Efectivo
- Efectivo
Aumentar la circulación /
tratar el aire interior
Traer aire del exterior Aumentar la circulación al traer
aire del exterior mediante el sistema HVAC puede ayudar
a eliminar el aire potencialmente infeccioso.
Trate el aire interior: los dispositivos de filtración portátiles
que se utilizan en el interior pueden ayudar a eliminar las
partículas potencialmente infecciosas del aire.
Crear barreras físicas entre el
personal médico y las estaciones
de trabajo
Las paredes temporales entre las estaciones
de trabajo reducen la posibilidad de que el
personal médico asintomático transmita
COVID-19 a otro personal médico.
Crear barreras físicas entre el
personal médico y residentes
Las barreras como el plexiglás (que no se muestran
aquí) permiten la comunicación y el acceso visual entre
el personal médico y los residentes mientras aíslan a
los residentes de posibles patógenos.
05-11-20v
07-24-20
�
Guide
Document providing operation or response information, general guidance documents.
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Controles de ingeniería para cuidados a largo plazo
Subject
The topic of the resource
Elementos en Español
Description
An account of the resource
Spanish Language version of <a href="https://repository.netecweb.org/items/show/1274">Engineering Controls for Long-term Care</a>. Engineering controls can be implemented to isolate people from a hazard and provide protection for long-term care residents and staff.<br /><br />
<p>Se pueden implementar controles de ingeniería para aislar a las personas de un peligro y brindar protección a los residentes y al personal de cuidados a largo plazo.</p>
Creator
An entity primarily responsible for making the resource
NETEC
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-09-21
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-01-01
2019-nCoV
Coronavirus
COVID-19
Engineering Controls
Español
Infection Prevention and Control
Long-term Care
Physical Infrastructure
R-LTC
R-PhIn
Spanish
-
https://repository.netecweb.org/files/original/ed58dc343d43eac08b2f66882f723377.png
ffa8193d03702a0b82a1a1ca19b763a4
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Webinar
Portal access to a webinar
Duration
Length of time involved (seconds, minutes, hours, days, class periods, etc.)
Friday, May 1, at 1:30-3:00 pm ET
Event Type
Webinar, register in link from page below.
URL
https://www.cdc.gov/nhsn/ltc/covid19/index.html
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
COVID-19 Enrollment Guidance for Long-term Care Facilities
Subject
The topic of the resource
Infection Control
Description
An account of the resource
CDC’s NHSN has built a customizable module for long term care facilities to track infections and prevention process measures in a systematic way. Join this webinar to learn about the enrollment process and guidance.
Creator
An entity primarily responsible for making the resource
CDC
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-05-01
Contributor
An entity responsible for making contributions to the resource
2022-12-07 general asset review - IPC (change R-LTC/T&C)
2024-03-28 by J. Mundy – IPC review 2023 (Q2) skipped – bumping to 2024 (Q2)
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-12-10
Identifier
An unambiguous reference to the resource within a given context
Adult Care
2019-nCoV
Coronavirus
COVID-19
Infection Prevention and Control
Long-term Care
R-LTC
R-T&C
-
https://repository.netecweb.org/files/original/8d0dd43bd3566808ae6d84e2fdbf309e.png
ffa8193d03702a0b82a1a1ca19b763a4
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Webinar
Portal access to a webinar
Duration
Length of time involved (seconds, minutes, hours, days, class periods, etc.)
Thursday, April 30, at 1:30-3:00 pm ET
Event Type
Webinar, register in link from page below
URL
https://www.cdc.gov/nhsn/ltc/covid19/index.html
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
COVID-19 Module Overview for Long-term Care Facilities
Subject
The topic of the resource
Infection Control
Description
An account of the resource
CDC’s National Healthcare Safety Network (NHSN) provides healthcare facilities, such as long term care facilities with a customized system or module to track infections and prevention process measures in a systematic way. Join the webinar to learn how the module can allow facilities to identify problems, improve care, and determine progress toward facility and national healthcare-associated infection goals.
Creator
An entity primarily responsible for making the resource
CDC
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-04-30
Contributor
An entity responsible for making contributions to the resource
2022-12-07 general asset review - IPC (change R-LTC/T&C)
2024-03-28 by J. Mundy – IPC review 2023 (Q2) skipped – bumping to 2024 (Q2)
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-12-10
Identifier
An unambiguous reference to the resource within a given context
Adult Care
2019-nCoV
Coronavirus
COVID-19
Infection Prevention and Control
Long-term Care
R-LTC
R-T&C
-
https://repository.netecweb.org/files/original/7957373e3db7cb81aa0811b1c37838f8.pdf
ad20abe35aed8b6006ca4820274e72be
PDF Text
Text
05-11-20v
07-24-20
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Guide
Document providing operation or response information, general guidance documents.
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Engineering Controls for Long-term Care
Subject
The topic of the resource
Physical Infrastructure
Description
An account of the resource
Engineering controls can be implemented to isolate people from a hazard and provide protection for long-term care residents and staff.
Creator
An entity primarily responsible for making the resource
NETEC
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-07-24
Contributor
An entity responsible for making contributions to the resource
2022-12-07 general asset review - IPC (move to LTC - now R-T&C)
2024-03-28 by J. Mundy – IPC review 2023 (Q2) skipped – bumping to 2024 (Q2)
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-12-10
Identifier
An unambiguous reference to the resource within a given context
Adult Care
2019-nCoV
Coronavirus
COVID-19
Infection Prevention and Control
Long-term Care
Physical Infrastructure
R-LTC
R-T&C
-
https://repository.netecweb.org/files/original/30d10a77239e1fddde203dddc7b1ff9e.png
3f501528330a5195fcab9cad4e0bb714
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Publication
A peer reviewed publication.
Citation
Citation information for the publication itself.
McMichael, Temet M., Dustin W. Currie, Shauna Clark, Sargis Pogosjans, Meagan Kay, Noah G. Schwartz, James Lewis, Atar Baer, Vance Kawakami, Margaret D. Lukoff, Jessica Ferro, Claire Brostrom-Smith, Thomas D. Rea, Michael R. Sayre, Francis X. Riedo, Denny Russell, Brian Hiatt, Patricia Montgomery, Agam K. Rao, Eric J. Chow, Farrell Tobolowsky, Michael J. Hughes, Ana C. Bardossy, Lisa P. Oakley, Jesica R. Jacobs, Nimalie D. Stone, Sujan C. Reddy, John A. Jernigan, Margaret A. Honein, Thomas A. Clark, and Jeffrey S. Duchin. 2020. "Epidemiology of Covid-19 in a Long-Term Care Facility in King County, Washington." New England Journal of Medicine 382 (21):2005-11.
Abstract
<h2 class="a-article-h2 f-h12">Background</h2>
<p class="f-body">Long-term care facilities are high-risk settings for severe outcomes from outbreaks of Covid-19, owing to both the advanced age and frequent chronic underlying health conditions of the residents and the movement of health care personnel among facilities in a region.</p>
<h2 class="a-article-h2 f-h12">Methods</h2>
<p class="f-body">After identification on February 28, 2020, of a confirmed case of Covid-19 in a skilled nursing facility in King County, Washington, Public Health–Seattle and King County, aided by the Centers for Disease Control and Prevention, launched a case investigation, contact tracing, quarantine of exposed persons, isolation of confirmed and suspected cases, and on-site enhancement of infection prevention and control.</p>
<h2 class="a-article-h2 f-h12">Results</h2>
<p class="f-body">As of March 18, a total of 167 confirmed cases of Covid-19 affecting 101 residents, 50 health care personnel, and 16 visitors were found to be epidemiologically linked to the facility. Most cases among residents included respiratory illness consistent with Covid-19; however, in 7 residents no symptoms were documented. Hospitalization rates for facility residents, visitors, and staff were 54.5%, 50.0%, and 6.0%, respectively. The case fatality rate for residents was 33.7% (34 of 101). As of March 18, a total of 30 long-term care facilities with at least one confirmed case of Covid-19 had been identified in King County.</p>
<h2 class="a-article-h2 f-h12">Conclusions</h2>
<p class="f-body">In the context of rapidly escalating Covid-19 outbreaks, proactive steps by long-term care facilities to identify and exclude potentially infected staff and visitors, actively monitor for potentially infected patients, and implement appropriate infection prevention and control measures are needed to prevent the introduction of Covid-19.</p>
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
Free online on NEJM
URL
https://www.nejm.org/doi/full/10.1056/NEJMoa2005412
Read Online
Online location of the resource.
https://www.nejm.org/doi/full/10.1056/NEJMoa2005412
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Epidemiology of Covid-19 in a Long-Term Care Facility in King County, Washington
Subject
The topic of the resource
Treatment & Care
Description
An account of the resource
After identification on February 28, 2020, of a confirmed case of Covid-19 in a skilled nursing facility in King County, Washington, Public Health–Seattle and King County, aided by the Centers for Disease Control and Prevention, launched a case investigation, contact tracing, quarantine of exposed persons, isolation of confirmed and suspected cases, and on-site enhancement of infection prevention and control.
Creator
An entity primarily responsible for making the resource
McMichael, Temet M., Dustin W. Currie, Shauna Clark, Sargis Pogosjans, Meagan Kay, Noah G. Schwartz, James Lewis, Atar Baer, Vance Kawakami, Margaret D. Lukoff, Jessica Ferro, Claire Brostrom-Smith, Thomas D. Rea, Michael R. Sayre, Francis X. Riedo, Denny Russell, Brian Hiatt, Patricia Montgomery, Agam K. Rao, Eric J. Chow, Farrell Tobolowsky, Michael J. Hughes, Ana C. Bardossy, Lisa P. Oakley, Jesica R. Jacobs, Nimalie D. Stone, Sujan C. Reddy, John A. Jernigan, Margaret A. Honein, Thomas A. Clark, and Jeffrey S. Duchin.
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-05-21
Type
The nature or genre of the resource
Publication
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-01-01
2019-nCoV
Coronavirus
COVID-19
Epidemiology
Long-term Care
R-LTC
-
https://repository.netecweb.org/files/original/63fb30ebe4f56532546e833b40e75113.pdf
71b87e5c596706d33714c421753da6c0
PDF Text
Text
Infection Prevention & Control in the Long-Term Care Setting:
Cleaning and Disinfection
Cleaning &
Disinfection
Environmental
Cleaning
Minimizing
Risk
Care of
Environment
Introduction
Long-term care (LTC) settings are communities where residents congregate
closely in shared spaces, and equipment is used between residents, staff,
visitors, and vendors who enter and leave frequently. This makes LTC an ideal
environment for germs to spread and risks the lives and well-being of residents
and staff.
Proper cleaning and disinfection is crucial to preventing and controlling the
spread of any infection. Like many processes, cleaning and disinfection must be
done correctly to be effective. This resource will provide all staff in the long-term
care setting with information to help them understand and perform the steps
required to clean and disinfect properly.
CONTROL
THE
CLUTTER
Image
Image
Image
Right
Cleaning &
Disinfection
Environmental
Cleaning
Wrong
Minimizing
Risk
Care of
Environment
Click each tab for an overview of each LTC PPE Education section
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�Infection Prevention & Control in the Long-Term Care Setting:
Cleaning and Disinfection
Cleaning &
Disinfection
Environmental
Cleaning
Minimizing
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Care of
Environment
Essential Definitions
Cleaning:
The removal of visible contamination and to prepare for disinfection.
Some organic or inorganic materials can interfere with the disinfectant’s
effectiveness by diluting the concentration or acting as a barrier for the
germs from the disinfectant.
Disinfection:
The process of destroying germs. Disinfectants destroy the cell wall of germs or
interferes with their metabolism. Disinfection should be done frequently on
high-touch surfaces to prevent the spread of germs that can cause infections.
Sterilization:
The process of destroying or eliminating all germs. Sterilization can be done in
several ways, such as using peroxide gas, ultraviolet light, or autoclaving with
very hot pressurized steam.
Contact Time:
The time required for a surface to stay wet with a disinfectant to successfully
destroy any germs present.
Contamination:
The presence or the reasonably anticipated presence of blood or other
potentially infectious materials on an item or surface. It may or may not be
visible to the naked eye. For example, a resident uses his hands to cover his
cough, then touches the handrail.
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�Infection Prevention & Control in the Long-Term Care Setting:
Cleaning and Disinfection
Cleaning &
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Environmental
Cleaning
Minimizing
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Care of
Environment
Cleaning
Steps to Clean:
1. Don necessary PPE.
2. Utilize a washable cloth (single designated use) or a disposable wipe to
remove contaminants from the surface.
3. Use multiple wipes and good friction to remove visible contaminants as needed.
4. Dispose of wipes properly per facility/agency protocol.
5. Remove gloves and perform hand hygiene.
Cleaning should be completed with a cloth or a towel, not a disinfectant wipe. Other examples
of items utilized for cleaning include a broom, mop dampened with water, or a duster.
Cleaning ALWAYS comes before disinfection
Expert tip: Do not reuse the same cleaning cloth from room to room or resident to resident.
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�Infection Prevention & Control in the Long-Term Care Setting:
Cleaning and Disinfection
Cleaning &
Disinfection
Environmental
Cleaning
Minimizing
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Care of
Environment
Disinfection
Key Alert:
Before you disinfect, you must “know” your disinfectant:
• What is it effective against?
• What is the contact time required to kill the germs?
• Is it expired?
Using your resources:
The label will identify what the
disinfectant is effective against and
the contact time.
If you cannot see the effectiveness or
contact time on the label, you can find
that information by searching the
product’s EPA registration number on
the following website:
https://cfpub.epa.gov/wizards/disinfectants/
Expert tip: Verify that the disinfectant is not expired.
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�Infection Prevention & Control in the Long-Term Care Setting:
Cleaning and Disinfection
Cleaning &
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Environmental
Cleaning
Minimizing
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Care of
Environment
Disinfection
Steps to Disinfect:
1. Don the necessary PPE.
2. Utilize a disposable disinfectant wipe approved and available at your facility to wipe
down the sides and surfaces of the dirty item or surface.
3. Use multiple wipes as needed to ensure the surface is thoroughly disinfected (ensure
proper wet contact time).
4. Dispose of wipes per agency/facility protocol.
5. Remove gloves and perform hand hygiene.
Some examples to consider during the disinfection process:
• Write the contact time on the container with a bold permanent marker.
• Do not store bleach in a transparent container because it will lose effectiveness.
• For example, when adding bleach from a jug to a clear spray bottle.
• Do not fan (with hand, mechanical fan, or wipe off) disinfectant to speed up drying time.
• Disinfect fabric furnishings like couches with a steam cleaner (professional cleaner).
Do NOT disinfect without cleaning first
Disinfection always happens AFTER cleaning
Expert tip: Contact time = The amount of time a disinfectant needs to stay wet to kill germs.
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�Infection Prevention & Control in the Long-Term Care Setting:
Cleaning and Disinfection
Cleaning &
Disinfection
Environmental
Cleaning
Minimizing
Risk
Care of
Environment
Cleaning STARTS by first identifying what is ‘dirty’
• Surfaces can be dirty without showing any visible signs of uncleanliness.
• High-touch surfaces and shared areas should be cleaned and
disinfected frequently and routinely to prevent the spread of
germs between residents, staff, visitors, and vendors.
High-touch Surfaces
•
•
•
•
•
•
•
•
•
Shared Spaces
Doorknobs/handles
Light switches
Tabletops / including bedside tables
TV remotes
Phones
Call lights/call light pendants
Handrails/side rails/safety handrails
Bedside commode handles/grab bars
Medication carts
•
•
•
•
•
•
•
•
•
Bathrooms
Dining room
Chapel
Salon
Resident rooms
Breakroom
Post-acute therapy areas
Conference rooms
Nurse's stations
Regularly scheduled rounding should be created within facilities to ensure cleaning and
disinfection occurs at regular intervals for certain surfaces or locations.
Surface Example
Space Example
Handrails in halls are wiped down hourly by assigned staff.
Chapel is cleaned and disinfected between services.
Cleaning and disinfection is the duty of ALL LTC staff
Expert tip: Assume all surfaces are contaminated.
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�Infection Prevention & Control in the Long-Term Care Setting:
Cleaning and Disinfection
Cleaning &
Disinfection
Environmental
Cleaning
Minimizing
Risk
Care of
Environment
Cleaning & Disinfection Process in Action
1
Infection prevention & control always starts with keen
observation. A staff member making a scheduled round enters a
resident’s room and identifies a dirty bedside table.
2
Once identified, the staff member will don the appropriate PPE.
PPE should reflect the task at hand and protect the staff
member from contamination.
3
Once the PPE is donned, the staff member will dispose of the
dirty tissues, wipe up the spilled food, and then controls the
clutter by better positioning the phone and TV remote.
4
After the cleaning process, the staff member will change gloves
in preparation for disinfection. Even though the surface is now
clean, the gloves worn during cleaning are considered dirty.
5
The disinfection process starts by reading the disinfectant label
for contact time. The staff member should refer to a clock or
watch to ensure that the manufacturer’s contact time has been
met. The table, TV remote, and phone can now be disinfected
with that knowledge.
A realistic scenario
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�Infection Prevention & Control in the Long-Term Care Setting:
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Minimize Risks of Contamination: Waste & Linen Bins
Examples of ways to minimize the risk of contamination:
• Empty trash and linen when they are ¾ full rather than completely full.
• Do NOT stomp or push trash down to make more room. Stomping and pushing trash down
can disperse particles that may be infectious.
• Make sure the liner fits the waste bin, so you do not have to tie a knot at the rim to fit.
• When emptying trash and linen, be sure to hold away from the body to prevent accidental
contamination.
• Check the waste bin before leaving the room; waste should be handled with PPE donned.
• When trash needs to be emptied in the room of a resident with an infection, trash bags can
be passed through the doorway’s threshold to another staff member for proper disposal.
This prevents contamination during the doffing process.
Expert tip: You can never be sure about what has been placed in the trash. Always handle with
care.
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�Infection Prevention & Control in the Long-Term Care Setting:
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Cleaning &
Disinfection
Environmental
Cleaning
Minimizing
Risk
Care of
Environment
Minimize Risks of Contamination: Cleaning Opportunities
Add cleaning and disinfection to the regular resident care flow
• When completing resident care, consider cleaning the space, disinfecting high-touch
surfaces nearby, and recognizing potential contamination sites. These are all essential
tasks in preventing the spread of germs.
A realistic scenario on how to use time more effectively
Adding a cleaning and disinfection opportunity to regular resident care
starts with observant staff
Common resident care moment
A resident calls for assistance to get to the restroom.
A cleaning opportunity is observed
While the resident is in the restroom, the observant staff
member sees a used cup and a dirty table. With the cleaning opportunity identified, they
remove the dirty cup, clean the table, then disinfect the tabletop. After verifying the
disinfectant’s wet contact time, they prepare a clean cup filled with water for the resident.
Expert tip: Do not use the same disinfectant wipe for multiple surfaces/objects.
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Cleaning and Disinfection
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Disinfection
Environmental
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Minimizing
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Minimize Risk of Contamination: Control Clutter
Still
Image
• Preventing clutter in residents’ rooms and shared
areas makes cleaning and disinfection easier by
preventing barrier development as well as
minimizing the risk of falls and spills.
1
2
Do not leave wheelchairs open in the
middle of the room. Clean and
disinfect the chair, then store out of
the way of traffic.
Clean and disinfect the table
after removing the finished
meal tray or dishes.
3
4
Used lap blankets in common areas
should be carefully rolled up and
placed with soiled linen. Then clean
and disinfect the chair.
Discourage personal items from
being abandoned in common areas.
Return those items to the resident
and then clean and disinfect area.
Expert tip: Eliminate hiding spots for germs by not allowing clutter.
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�Infection Prevention & Control in the Long-Term Care Setting:
Cleaning and Disinfection
Cleaning &
Disinfection
Environmental
Cleaning
Minimizing
Risk
Care of
Environment
A CLEAN space is a SAFE space
Examples of ways to keep the space safe:
• Maintain an inventory log of cleaning and disinfectant products, include the expiration
dates and how much is on hand.
• Safety Data Sheets (SDS) binders need to be readily available; verify that the product
sheets match the product inventory.
• Keep chemicals locked up to protect ambulatory residents from exposure or ingestion
and monitor chemicals at all times while in use.
• Vacuuming can cause infectious particles to disperse into the air and come in contact
with people nearby; opt for facility vacuums with HEPA filters (preferably brushless).1
• Fans should be discouraged (especially when there is a risk for infection) as the
blowing air can provide a way for aerosolized germs to spread.
• Clean and disinfect Durable Medical Equipment (DME) between residents to prevent
the spread of infection.2
• Clean computers, keypads, keyboards, telephones, and computer mice on a routine
basis and as needed.
• Keep detailed infection control logs.3
1
2
3
Expert tip: Cleaning & Disinfection is EVERYONE's business!
7.27.2022
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Guide
Document providing operation or response information, general guidance documents.
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Infection Prevention & Control in the Long-Term Care Setting: Cleaning and Disinfection
Subject
The topic of the resource
Infection Control
Description
An account of the resource
Long-term care (LTC) settings are communities where residents congregate closely in shared spaces, and equipment is used between residents, staff, visitors, and vendors who enter and leave frequently. This makes LTC an ideal environment for germs to spread and risks the lives and well-being of residents and staff.<br /><br />Proper cleaning and disinfection is crucial to preventing and controlling the spread of any infection. Like many processes, cleaning and disinfection must be done correctly to be effective. This resource will provide all staff in the long-term care setting with information to help them understand and perform the steps required to clean and disinfect properly.<br /><br />This printable flyer (infographic) discusses:<br />
<ul>
<li>Cleaning & Disinfection</li>
<li>Environmental Cleaning</li>
<li>Minimizing Risk</li>
<li>Care of Environment</li>
</ul>
Creator
An entity primarily responsible for making the resource
NETEC
Date
A point or period of time associated with an event in the lifecycle of the resource
2022-07-27
Contributor
An entity responsible for making contributions to the resource
2023-08-24 - general ongoing review - IPC - Caroline/Trish - 3yr
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2026-08-27
Cleaning
Disinfection
Infection Prevention and Control
Long-term Care
Personal Protective Equipment (PPE)
R-IPC
R-LTC
-
https://repository.netecweb.org/files/original/6d7efb7dcce87bcd1500fba67459d56c.pdf
cadae1253829b6cadd1bb2c3a2b5c168
PDF Text
Text
Long-Term Care (LTC) and Assisted Living
Facility Biosafety: Identify, Isolate and Inform
Introduction
According to the CDC, people who are at the most risk for severe complications after contracting COVID-19 are over the age of
65 and anyone with underlying medical conditions. Many residents in long-term care and Assisted Living facilities meet both
these conditions. Because they live near each other and are cared for by staff, who move throughout the facility, a single case
of COVID-19 can easily lead to an outbreak within a highly vulnerable population.
For this reason, it is imperative that long-term care facilities put measures in place to protect the residents within, and that
includes being able to identify when a case or risk of a case is present, isolate the hazard, and inform individuals who need to
know to activate resources to mitigate further spread.
Identify
Isolate
Inform
Click each tab for an overview of each strategy when suspecting a resident(s) of having COVID-19
12.12.2020
�Long-Term Care (LTC) and Assisted Living
Facility Biosafety: Identify, Isolate and Inform
Identify has three focal points
1
Identify when someone enters the facility with signs and symptoms of COVID-19:
2
Identify when staff or residents become ill with COVID-19:
3
Identify asymptomatic carriers of COVID-19:
• Restrict entry points to control how people enter the facility.
• Have a process to screen everyone who enters the facility for signs and symptoms of COVID-19.
• Maintain a record of who is entering the facility to assist with contact tracing if necessary.
• Employ source control measures such as universal masking, hand hygiene, and physical distancing.
• LTC facilities should assess for signs and symptoms of COVID-19 during routine care activities each shift.
• In ALF, observe for and encourage residents to report signs and symptoms of COVID-19.
• Have a plan in place for staff to report the onset of COVID-19 signs and symptoms.
• Utilize routine testing to identify when residents or staff are asymptomatic carriers of COVID-19.
12.12.2020
�Long-Term Care (LTC) and Assisted Living
Facility Biosafety: Identify, Isolate and Inform
In long-term care facilities, quarantine and isolation are employed as methods to mitigate
the spread of infection.
Quarantine methods (for individuals who have had a potential or unknown exposure risk):
• Restricting visitation to non-essential staff and visitors is one way of providing reverse quarantine to protect
residents from outside sources of infection.
• Residents with no symptoms of COVID-19 but have risk factors for potential exposure, such as a resident who
attends dialysis outside of the facility where exposure to COVID-19 is unknown, should be quarantined in a
designated area to prevent the possible spread of COVID-19 to other residents.
Isolation methods (for individuals confirmed to be infected with COVID-19):
• Residents who have tested positive should be isolated to prevent the spread of COVID-19.
• Depending on your situation, residents can be isolated in their individual rooms or a dedicated
space such as a wing or group of rooms at the end of a hallway.
• Residents who have signs or symptoms and have not yet received test results should be isolated but NOT in
the same area as residents who are known to be positive.
Recommendation
If staffing allows, staff working with COVID positive residents
should be cohorted to only work with this group.
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�Long-Term Care (LTC) and Assisted Living
Facility Biosafety: Identify, Isolate and Inform
Inform encompasses communication with individuals external and internal to the facility.
External communication:
• CMS requirements:
• For example: reporting information on cases, staffing, and supply information to the CDC’s National
Healthcare Safety Network (NHSN) or other as required by CMS.
• Notifying representatives and families of residents on the status of COVID-19 in the facility, including updates
on new cases.
• Local and State public health may also require being informed, which may activate resources and support as
needed.
• Essential vendors such as home health agencies, hospice, and delivery companies will need to be informed of
infection control measures such as how to enter the building and what is required for source control.
Internal communication:
• CMS internal requirements:
• Informing all residents on the status of COVID-19 within the facility, including updates on new cases.
• Residents and staff need to be informed of infection control measures such as isolation, quarantine, and
source control measures being taken.
• If a resident or staff member is identified as having symptoms of COVID-19, they will need to be informed of the next steps.
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�Long-Term Care (LTC) and Assisted Living
Facility Biosafety: Identify, Isolate and Inform
Resources
CDC – People at Increased Risk:
https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-at-increased-risk.html
CDC – Nursing Homes and Long-Term Care Facilities:
https://www.cdc.gov/coronavirus/2019-ncov/hcp/nursing-home-long-term-care.html
CDC –Long-Term Care Facilities: CMS Flexibilities to Fight COVID-19:
https://www.cms.gov/files/document/covid-long-term-care-facilities.pdf
ASPR TRACIE Toolkit for Long-term Care Facilities:
https://files.asprtracie.hhs.gov/documents/aspr-tracie-covid-19-long-term-care-considerations-toolkit-final.pdf
12.12.2020
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Guide
Document providing operation or response information, general guidance documents.
Dublin Core
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Title
A name given to the resource
Long-Term Care (LTC) and Assisted Living Facility Biosafety: Identify, Isolate and Inform
Subject
The topic of the resource
Treatment & Care
Description
An account of the resource
This printable flyer infographic discusses Long-Term Care (LTC) and Assisted Living Facility Biosafety: Identify, Isolate and Inform.
Creator
An entity primarily responsible for making the resource
NETEC
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-12-12
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-01-01
2019-nCoV
Biosafety
Coronavirus
COVID-19
Identify
Inform
Isolate
Long-term Care
R-LTC
-
https://repository.netecweb.org/files/original/b5c13f52031cb36625f1cf85688405fb.pdf
a6a2394076ae4fd8f1021d86a519c8b8
PDF Text
Text
Long-Term Care
Personal Protective Equipment (PPE) Education
Knowledge
Utilization
Administration
Logistics
Introduction
Welcome to NETEC education on Personal Protective Equipment (PPE) that has been developed specifically
for Long-term Care (LTC) Facilities.
The content in this education has been grouped into sections that will allow you to learn or refresh your knowledge on critical
concepts of PPE management and use. You have the option of reviewing all or just the part of the content depending on
your interest or need.
Information in this downloadable PDF is targeted towards all professionals in LTC, from administration to the frontline workers.
Image for knowledge
Staff in PPE with
resident or performing
work task
Knowledge
Image for
Utilization
Image for
Administration
Image for
Logistics
donning
Trainer and
Staff member
Supplies
CU
Utilization
Administration
Logistics
Click each tab for an overview of each LTC PPE Education section
9.1.2021
�Long-Term Care
Personal Protective Equipment (PPE) Education
Knowledge
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Infectious diseases are caused by types of bacteria, viruses, parasites, and fungi around us. It is
important to understand how these diseases are transmitted.
The Chain of Infection
The chain of infection describes how an infection moves from one individual to another:
• Infection occurs when all links are intact
• We have multiple opportunities to break the chain and stop infection (e.g., hand hygiene)
• Correctly using PPE is one way for us to break this chain and stop the spread of infection
Direct and Indirect Contact
EXAMPLES:
Direct contact is when transmission occurs through direct person-to-person contact:
• When an infected person touches another person
• When an infected person exchanges body fluids with someone else
• Droplet spread; the spray of droplets infect another person
• Coughing, sneezing and talking in close proximity to another person
EXAMPLES:
Indirect contact is when transmission occurs when there is no direct person-to-person contact:
• Insect bites
• Touching contaminated objects
• Environmental factors
• Animal-to-person contact
• Touching/consuming contaminated food and drinking water
If you understand the transmission process, then you can use that knowledge to protect yourself
Expert tip: with the appropriate PPE and help prevent the spread of the illness.
9.1.2021
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If you understand the transmission process, then you can use that knowledge to protect yourself
with the appropriate PPE and help prevent the spread of the illness.
Personal protective equipment (PPE) acts as a barrier that prevents germs from entry and exit:
How and
when does
PPE Work?
• Blocks exit from an infected person
• PPE Example – the use of masks for source control
• Blocks entry to a new host, preventing infection
• PPE Example – the use of goggles to protect the eyes from exposure
PPE also prevents germs from contaminating the clothing or hands of staff and
being carried elsewhere (e.g., use of gowns to protect clothing from contamination)
PPE provides protection to:
Who does
PPE work
for?
•
•
•
•
•
The individual wearing the PPE
Other staff working in the facility
The resident receiving care
Other residents in the facility
Example - if a resident comes into contact with the hands or clothing of a
contaminated healthcare worker the germs can transfer to them
Expert tip: When used correctly, PPE is our healthcare armor. It keeps everyone safer from germs that cause infection.
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Knowledge
What is PPE in Long-term Care:
• PPE is worn to minimize exposure to specified hazards
• PPE is specialized clothing or equipment, worn by the staff for protection against infectious materials
• PPE is designed to protect individuals from illness, disease, or injury resulting from workplace-related hazards
• PPE helps to prevent the spread of harmful germs (pathogens) to others
PPE Categories:
Hand Hygiene
Gloves
Gowns
Masks/Respirators
Expert tip: PPE is worn to minimize exposure to hazards. Use facility-approved PPE.
9.1.2021
Eye Protection
�Long-Term Care
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Knowledge
Administration
Hand Hygiene, when performed correctly, hand hygiene will
prevent the spread of germs through the hands.
When are clean hands important? Any time there is a risk for transferring germs!
To protect self and staff:
To protect residents:
Hand Hygiene with
Alcohol-Based Hand Rub
*Note: these are not comprehensive lists because hand hygiene should take place whenever the opportunity exists
•
•
•
•
•
•
Before any care task
Entering a resident’s room
Touching the resident and their surroundings
Food preparation
Participating in pet therapy
Donning PPE
• Touching high-touch surfaces like
keyboards or telephones
• Doffing PPE
• After any care task
• Before entering the workplace
• Before eating or drinking
Why do we perform hand hygiene? Stops the spread of germs and reduces illness!
Protects:
Protects those at work
• Residents
• Co-workers
• You
Protects those outside of work
The entire process
must take no less than
20 seconds
• Family
• Friends
• Community
Expert tip: A hand hygiene action should be performed whenever an opportunity for hand hygiene exists.
9.1.2021
Continue to rub until dry
�Long-Term Care
Personal Protective Equipment (PPE) Education
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Gloves protect your hands against contact with infectious materials. However, once contaminated, gloves can
become a means for spreading infectious materials to yourself, residents, and environmental surfaces.
Gloves should be well fitted and not be too tight or too loose-fitting.
The Do's and Don'ts of wearing gloves
•
•
•
•
•
•
•
When possible, work from “clean to dirty”
Do limit opportunities for “touch contamination”
Do change gloves if torn or heavily soiled (even during use on the same resident)
Do change gloves after use on each resident
Do discard in an appropriate waste receptacle
Do wear gloves that appropriately cover the wrists
Do minimize contact with environmental surfaces
•
•
•
•
•
Do not touch your face
Do not launder or reuse disposable gloves
Do not wear ill-fitting gloves
Do not remove gloves in an unsafe manner
Do not dispose of gloves in an unsafe manner
• Gloves should be gently placed in the appropriate waste receptacle
in order not to aerosolize germs
Perform hand hygiene
FREQUENTLY
Gloved or ungloved,
hands carry germs
Expert tip: The way you use gloves can influence the risk of disease transmission in your long-term care setting.
9.1.2021
�Long-Term Care
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Gowns help prevent germs from getting on your skin and clothing. Gowns should fully cover the torso, fit
comfortably over the body, and have long sleeves that can be well tucked into the gloves. Purpose of
use will greatly influence the selection of a gown as PPE. If you are likely to encounter wet surfaces,
splashes or sprays, look for a gown or apron that is labeled fluid impermeable or fluid resistant.
The Do's and Don'ts of wearing a gown
• Do wear facility-provided gowns
• Do ensure gown is fastened/closed properly
• Do check for rips, tears, holes, or if soiled
• A resident grabbing/pulling on a gown may compromise
the PPE integrity
• Do remove & dispose of according to facility protocols
• Do launder washable gowns between each use
• Do make sure that gown wrist cuffs are tucked into gloves
• Do be aware of where the highest risk of contamination on the
gown exits
•
•
•
•
Do not reuse disposable gowns
Do not wear ill-fitting gowns
Do not launder disposable gowns
Do not lean against contaminated surfaces
When assisting a resident, the entire front of the gown
should be considered at risk for contamination
Expert tip: Gowns must be doffed properly to prevent self-contamination!
9.1.2021
�Long-Term Care
Personal Protective Equipment (PPE) Education
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Facemasks are worn by staff and residents to prevent the transmission of infectious diseases. Face masks can
help protect against respiratory infections that are spread through the droplet route.
The Do's and Don'ts of wearing a face mask
• Do perform hand hygiene before donning a mask
• Do allow residents to wear cloth masks
• Do launder cloth masks frequently
• Do place the mask over the nose and mouth and secure it under the chin
• Do fit the mask snugly against the sides of face, slipping the loops over
the ears or tying the strings behind the head
• Do dispose of facemasks properly per facility protocol
•
•
•
•
Do not leave your chin or mouth exposed or dangle the mask from one ear
Do not put the mask around the neck or up on forehead or hang on arm
Do not re-use unless otherwise indicated
Do not wear masks that are not facility approved
If your mask doesn't fit snugly on the sides of your face,
Expert tip: try tying a knot behind the ear to make the mask tighter.
9.1.2021
Example of a knot that will shorten the facemask straps,
known as a “Overhand on a Bight” knot
�Long-Term Care
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Filtering Facepiece Respirators (FFRs) such as N95s are designed to fit tightly against your face to prevent
air from entering or leaving from the sides. That way, all the air you breathe in or out passes thru
the special filter material to trap particles.
The Do's and Don'ts of wearing a respirator
•
•
•
•
•
Do perform hand hygiene before donning a respirator
Do perform a fit test for a tight-fitting respirator according to OSHA guidance
Do make sure the respirator covers the nose and mouth
Do always perform a user seal check to help ensure a proper seal
Do make sure to position both straps properly
• the upper strap should be positioned on the crown of the head and the lower strap positioned below the ears
•
•
•
•
•
•
Do not adjust the respirator after a fit seal has been secured
Do not wear the respirator with facial hair that will prevent a seal - CDC Facial Hairstyles and Filtering Facepiece Respirators.pdf
Do not wear just one strap
Do not wear both straps above or below ears
Do not twist or cross straps
Do not wear earrings that can get caught in the straps
Expert tip: Respirators with expiratory valves should not be worn as they allow exhaled air to bypass the filter.
9.1.2021
Example of respirator
with exhalation valve
�Long-Term Care
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Respiratory Protection Program (RPP)
• OSHA requires all Long-term Care facilities to have a written RPP that is specific to each facility and
provides details on:
• What respirators are used at the facility
• When respirators will be used
• How respirator fit testing is performed
• How staff are medically evaluated as able to wear a respirator
• How respirators are stored and maintained
• How staff are trained on what their respiratory risks are
• How staff are trained on how to wear a respirator
• How the RPP is evaluated and updated https://www.osha.gov/sites/default/files/respiratory-protection-covid19-long-term-care.pdf
• Staff training should include how to properly:
• Put on a respirator
• Perform a user seal check
• Take off the respirator
In addition to regularly scheduled training, additional training should occur when:
• Staff receives a new work assignment that has different respiratory hazards and respirator requirements from a
previous old job
• Staff cannot recall information and skills needed to use the respirator properly. This could occur when the staff
member uses a respirator only a few times a year
• A situation comes up in which retraining is necessary to ensure safe respirator use, e.g., when an individual is
observed not using the respirator properly
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Eye Protection provides barrier protection for the eyes. Personal prescription lenses do not provide adequate
eye protection and should not be used as a substitution for goggles or a full-face shield.
Goggles should fit snuggly over and around the eyes or over personal prescription lenses.
The Do's & Don'ts of eye protection
Protection from:
• Do perform hand hygiene before donning eye protection
• Do wear facility provided/approved eye protection
• After being cleaned, eye protection can be stored on hooks, in
isolation carts, or in any clean area that works for a specific space
• Droplet transmission of pathogens
• Other potential hazards, such as
bodily fluid sprays
• Do not wear personal prescription eyeglasses as PPE
• Additionally, do not attach eye shields to personal eyeglasses.
This will still not be considered adequate eye protection
• Do not position eye protection on the top of head when not in use
• Do not alter face shields in any way
Expert tip: Eye protection can fog up; try applying facility-approved anti-fog solution prior to donning.
9.1.2021
�Long-Term Care
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Additional PPE
Additional PPE should be worn when the task at hand or the job position requires more.
Follow facility guidance for when additional PPE is necessary. Care must be taken so that the
additional PPE does not interfere with the fit and design of the base ensemble. PPE should be
removed and properly disposed of, and handwashing should follow immediately.
Follow CDC recommendations for what PPE is required
Your job may require you to wear additional items,
e.g., culinary staff will need to wear hair nets
Only use facility provided or approved PPE
Expert tip: Additional items may require different donning and doffing sequences – work with your ICP to design facility protocols.
9.1.2021
�Long-Term Care
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Using this guidance, staff can determine what type of respiratory PPE should be used when
working with residents and under what circumstances.
Face Masks
Intended use
Filtering Facepiece
Respirators (FFRs)
Does not protect against small
airborne particles (aerosols)
Reduce staff inhalation of both
large droplets and aerosols
When
worn by
staff
Protect the staff member’s
nose/mouth from splashes
or sprays of large droplets
of bodily fluids
Protect the resident by reducing
the number of particles introduced
into the room as the staff member
talks, sneezes, or coughs
When
worn by
residents
Protect the staff by reducing the
number of particles introduced
into the room as the resident talks,
sneezes, or coughs
Not worn by residents
Fit tested
required?
No
Yes, required
9.1.2021
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PPE Compliance Challenges - When appropriately used, PPE will protect you, but it must be consistently
used in the way it was designed to be used.
Human factors that influence PPE compliance:
•
•
•
•
•
•
Fatigue
Habits
PPE knowledge
Motivation
Attitude
Skills
Facility factors that influence PPE compliance:
•
•
•
•
Policy and Standard Operating Procedures (SOPs)
Training provided
Culture
Policy/SOP enforcements
Personal protective equipment factors that influence PPE compliance:
•
•
•
•
Comfort
Ease of use
Ease of care
Replacement frequency
Expert tip: Be observant of PPE compliance. Kindly reinforce others to do it correctly. Stay positive and consistent to stay safe.
9.1.2021
�Long-Term Care
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PPE Compliance Solutions to the Challenges:
TRAIN!
• Provide staff training on the hazards and symptoms of worker fatigue
• Ensure staff is appropriately evaluated and trained for suitable work in the use of required PPE
• Avoid shaming (guilt) staff into PPE compliance – this causes staff to hide unsafe behaviors and creates additional
stress-fatigue
• Highlight and teach the importance of proper PPE application and removal techniques
• When possible, implement a buddy system to ensure the use of proper application and removal procedures
• Give praise and thanks for staff efforts
• Allow for appropriate breaks from PPE
• Encourage nurses, supervisors, and infection control specialists to be present on the floors or resident care areas
to perform on-the-spot checks, inspections, and guidance to staff
For staff performing home visits:
Training should include the complexities of donning and doffing PPE in unfamiliar settings and include putting PPE
on before entering the home, adherence to bag protocols, and personal hand sanitizer. Try to ‘mirror’ training
in a home-like setting.
Expert tip: Promote a culture of staff resiliency, in which reactions are expected. Let them know that we are all in this together.
9.1.2021
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PPE Utilization:
Successful PPE utilization requires that all staff must don the appropriate PPE. Wearing the wrong PPE for the task, donning
& doffing the PPE incorrectly, or working in a risky manner while donned in PPE hurts both the staff and the residents:
• Increases the risk of infection for the staff
• Risk of cross-contamination between the other residents
Critical thinking
Donning/doffing
High risk situations
Know the correct PPE
for the task
Know the correct order and
method for donning & doffing
Understand how everyday items,
such as jewelry, can affect your PPE
Expert tip: Donning the correct PPE will help protect yourself and protect those you are caring for.
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Critical Thinking: Identifying required level of PPE
• Use the resources available to determine what PPE is needed to protect against a specific pathogen (germ)
• CDC - Protecting Healthcare Personnel
• NETEC- Know Your PPE: COVID-19 Focused
• Facility protocols
• How the pathogen (germ) is transmitted/passed on to others will guide PPE selection
• Disease's chain of infection
• Disease’s direct and indirect contact risks
• Precautions that guide required PPE include: Standard, Contact, Enhanced Contact, Droplet, or Airborne
• PPE needs to be selected for the tasks at hand
Always assume you will come in contact with germs when you enter a room
Make sure PPE is donned and doffed correctly
Expert tip: Properly wearing the correct PPE ensemble will help break the chain of infection.
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�Long-Term Care
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Critical Thinking: Adding Armor
• You can always DO MORE with PPE, but you CANNOT DO LESS than what is recommended based upon CDC
guidelines for a specific pathogen
• Important: Any alteration can change the donning and doffing process. Therefore, critical thought must be put
into the donning and doffing process to ensure it keeps the staff safe. See the examples below:
Example of
doffing with additional PPE,
such as shoe covers & hairnet
Doffing PPE
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
1.Gown and gloves
2.Hand hygiene
3.Goggles or face shield
4.Hand hygiene
5.Respirator, facemask
6.Hand hygiene
Gown and gloves
Hand hygiene
Hair net
Hand hygiene
Shoe covers
Hand hygiene
Goggles
Hand hygiene
Respirator, facemask
Hand hygiene
Expert tip: Knowing and following the correct donning and doffing techniques will help keep staff safe!
9.1.2021
�Long-Term Care
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Donning & Doffing Preparation: Location
Depending on the infectious pathogen in question, donning and doffing locations and supplies may vary.
For the purpose of this education, donning and doffing will be focused on the care of a resident with disseminated varicella
(chickenpox) in a long-term care facility.
Selection of a donning and doffing location relies on multiple factors:
Functionality
• Is the location easily accessible for all the staff
• Example: Having gloves available in/on a designated cart just outside the resident rooms
Cleanliness
• Is the location free of dirty equipment and not at risk for contamination
Spacious
• Is there enough space for the staff to:
• Comfortably don PPE
• Perform safety checks before entering the resident care area
• Stock necessary PPE
Expert tip: Ensure you have the right precautions for the pathogen.
9.1.2021
�Long-Term Care
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Donning & Doffing Preparation: Supplies and Equipment
Items needed for a resident in contact & airborne precautions include:
• Gloves
• Hand sanitizer
• Gowns
• Trash bin
• Eye protection
• Donning/Doffing checklist
• Respirator (e.g., N95)
• Precaution signage
• Disinfectant wipes
• PPE storage container or bin
Outside of resident’s
room before supplies
have been added
Supplies stocked outside
of resident’s room
Expert tip: Have a process to ensure necessary supplies are stocked throughout each shift.
9.1.2021
Logistics
�Long-Term Care
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Utilization of the Donning Process: Best Practices
Donning: When you are preparing to enter a room with a resident, review the donning checklist located near (but not on) the
door and ensure you have all the supplies required to complete your task. After confirmation, you begin your donning process.
Doffing: The doffing process is the highest risk task for staff to accidentally self-contaminate. After reviewing the doffing
checklist located near the outside of the door, begin the doffing process.
Donning
• Perform hand hygiene before donning PPE
• Hydrate before starting the donning process
• Utilize the restroom before donning PPE
• Use a donning checklist
• Have the correct PPE ensemble
• Have the correct sizes
• Perform a safety check before entering the care area
• Contain hair – tie back and up, if long
• Don't wear jewelry that can damage or breach PPE
• Avoid jewelry that can get caught in facemask/respirator
straps, e.g., earrings
• Don’t rush the donning process
Doffing
• Use a doffing checklist
• Follow facility procedures
• Doff in the correct order
• Remove gross contamination prior to doffing
• Avoid touching skin and clothing while doffing
• Dispose of PPE appropriately
• Avoid touching the outside of PPE
• Perform hand hygiene if accidently touched
• Avoid aerosolization of germs when doffing
• Do not flap gown
• Do not throw or forcibly stuff doffed PPE
into waste container
• Maintain respiratory protection during the entire doffing procedure
• Don’t rush the doffing process
Expert tip: Do not adjust your PPE while in the resident care room.
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�Long-Term Care
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High Risk Situations: PPE Breaches versus PPE Gross Contamination
Gross Contamination of PPE
PPE Breach
A breach is when an item of PPE is torn or damaged,
and the staff is no longer adequately protected in
the resident care area
Gross contamination is when intact PPE becomes
contaminated with infectious substances – this will
require decontamination immediately in order to
continue resident care
Examples:
Contamination from emesis, sputum,
or stool on gown and gloves
Examples:
Tear in gloves or gown, respirator band breaking
or becoming overstretched
What to do:
Remove or absorb
contaminants with a
disposable towel,
followed by wiping PPE
with approved
disinfectant wipes
What to do:
Immediately doff out of
resident care area, follow
facility protocol for breach
of PPE inside the resident
care area
Torn gown sleeve
Contamination
Since some items of PPE are not wipeable, it may be necessary to remove the contaminated PPE being very
Expert tip: careful not to touch or expose other items to the contamination.
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High Risk Situations: Self-Awareness in PPE
•
•
•
•
•
Avoid touching your face, skin, and clothing while in the resident care area
Do not adjust your PPE while in the resident care area
When in doubt, change your gloves and perform hand hygiene
Ensure you have donned appropriately sized PPE before entering the resident care area
Monitor the safety of other staff in the room
High Risk Situations: Self-Awareness in the Environment
• Most high-risk situations can be avoided when self-awareness is maintained
in the resident care area
• Stay aware of your surroundings
• Have predetermined communication methods for both staff and residents
• Disinfect high touch surfaces often:
• Door handles
• Computer keyboards
• Door frames
• Telephones
• Bedside tables
• Nurse’s station desktop
• Toilet flush handle
• Resident charts
• Pens
• Sinks and taps
• Paper towel dispensers • Security keypads
• Durable medical equipment
• Bedside rails
This list is not conclusive
Expert tip: Slow down, take your time, and be deliberate.
9.1.2021
When in doubt,
change your gloves and
perform hand hygiene
�Long-Term Care
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Teaching and Training
PPE topics to cover with staff:
• Hand hygiene
• PPE (what, how, and why)
• Gloves
• Gowns (e.g., cloth, plastic)
• Source control – masks
• Eye protection – face shields, goggles
• Donning and doffing
• Skill competencies while donned in PPE
•
• Vitals
•
• Bathing and grooming
•
• Catheter care
•
• Nail care
•
• Oral care
•
• Ostomy care
•
• Dressing and undressing
Meal preparation and assist with feeding
Functional transfers
Safe restroom use (toileting) and maintaining continence
Medication & treatment administration
Oxygen administration or nebulizer treatments
Wound care
Obtaining labs
Expert tip: To protect against any staffing challenges, having more than one ‘EXPERT’ that can teach and train is recommended.
9.1.2021
�Long-Term Care
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Training techniques
Education means helping staff learn how to do things and encourage them to think about what they learned. Using more
than one learning modality is important for staff to acquire knowledge through study and imparting the knowledge by
way of return demonstration.
Use various modes of training to demonstrate skills learned:
• Didactic
• In-person
• Virtual
• Video or multimedia instruction
• E.g., NETEC Personal Protective Equipment for COVID-19 video
• https://youtu.be/bG6zISnenPg
• Interactive training
• Educator demonstrates skill
• Staff performs a return demonstration
• Competency evaluation
• Coaching
• Just-in-time education
Expert tip: Observe the staff in action! Teach/train in the moment, lead by example.
9.1.2021
�Long-Term Care
Personal Protective Equipment (PPE) Education
Knowledge
Utilization
Administration
Logistics
Teaching tips:
• Have a subject matter expert develop and deliver education
• Utilize train-the-trainer programs to disseminate knowledge to all shifts to reinforce best practice
• Know your audience (how does your team learn best?)
• Be prepared
• Document the education in all instances
• Encourage audience participation (empower your team to engage & provide feedback)
• Invite experts to teach/demonstrate
• Utilize technology (computers, tablets, cell phones)
• These are a source of education for tips, reminders, small education pieces
• Make the information being relayed engaging, understandable, interactive
Expert tip: Keep policy language basic, and incorporate links to guidelines such as CDC to further support the policy.
9.1.2021
�Long-Term Care
Personal Protective Equipment (PPE) Education
Knowledge
Utilization
Administration
PPE Standard Operating Procedures (SOPs) and Policy
Developing PPE SOPs/ policy will guide training needs.
Developing a policy on donning and doffing includes:
• Determining the PPE selection and ensemble
• Donning and doffing PPE protocols
• Donning and doffing locations
• Staff responsibilities
• Ordering and restocking strategies
Expert tip: Make sure your PPE donning and doffing SOP addresses all auditing and regulatory requirements.
9.1.2021
Logistics
�Long-Term Care
Personal Protective Equipment (PPE) Education
Knowledge
Utilization
Administration
Logistics
Logistics
It is essential to acquire both local and national supply chain market information so providers
can manage timely and more efficient responses at the onset of a disease outbreak and mitigate
the spread beyond an initial outbreak.
This section will address the following topics:
What is a PPE Ensemble
How Much PPE is Required
PPE Burn Rate Calculator
Extended Use and Reuse of PPE
Storing PPE
Expert tip: Be prepared for all conditions.
9.1.2021
�Long-Term Care
Personal Protective Equipment (PPE) Education
Knowledge
Utilization
Administration
Logistics
What is a PPE Ensemble
Droplet & Contact
Precautions
A PPE ensemble is the combination of items worn to break the chain of infection
and protect the staff and residents.
The ensemble is based on how a particular disease is spread and how the item of
PPE can provide a barrier or interrupt the transmission of a disease from occurring.
For example:
Goggles
Mask
• If a disease is spread by contact, it will be necessary to wear a gown and
gloves to prevent skin or clothing from coming into contact with
substances that may contain the pathogen that causes the disease
• If a disease is spread by droplet, it will be necessary to protect the airway
and eyes with a mask and eye protection to prevent breathing in the
pathogen or allowing it to enter our systems through our eyes
Gown
Gloves
If a disease is spread by more than one method,
it will require a combination of PPE
There are many variations of PPE ensembles – what’s important is that the ensemble worn protects the wearer against the
Expert tip: transmission route of the disease.
9.1.2021
�Long-Term Care
Personal Protective Equipment (PPE) Education
Knowledge
Utilization
Administration
How Much PPE is Required
How much PPE you will need is unique for every facility and will depend on several factors:
Your normal daily PPE consumption when caring for residents and assisting with:
•
•
•
•
•
Dressing
Bathing and showering
Toileting and changing incontinence briefs
Mobility and transfers
Wound care or care associated with devices such as an ostomy or urinary catheter
If there is a disease outbreak, the amount and type of PPE required will change due to:
•
•
•
•
The transmission route of the disease
The acuity or how ill the residents are
The number of residents who are sick
Potential for increased staffing needs
Expert tip: Assign a staff member to track how much PPE is being used.
9.1.2021
Logistics
�Long-Term Care
Personal Protective Equipment (PPE) Education
Knowledge
Utilization
Administration
Logistics
PPE Burn Rate Calculator
To understand how much PPE is required, you will need to know how much you are using.
CDC Burn Rate Calculator (internet search terms: PPE burn rate calculator)
https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/burn-calculator.html
• Begin by knowing how much you have on hand of each item of PPE
• Use the tool to enter how much PPE you have on subsequent days – this will calculate your:
• Consumption or burn rate
• Days of PPE supply remaining
• 5-day average burn rate
• By entering how many residents are ill, the calculator will estimate how much PPE is being
used per resident
For a tutorial on how to use the PPE burn rate calculator
(internet search terms: PPE burn rate calculator tutorial)
https://www.fedagent.com/news-articles/ppe-burn-rate-calculator-tutorial
Expert tip: Calculating your daily burn rate will help you stay informed on increasing or decreasing needs.
9.1.2021
�Long-Term Care
Personal Protective Equipment (PPE) Education
Knowledge
Utilization
Administration
Logistics
Extended Use and Reuse of PPE
When the availability of PPE is below the demand level, the CDC may issue Crisis Capacity Strategies in which items of PPE
that are normally used once and then disposed of can be:
• Used beyond their expiration date
• Used for more extended periods and worn when caring for multiple residents – extended use
• Items of PPE that are used and then stored appropriately can then be reused following CDC guidance on how to do it safely
– limited reuse
During times of crisis when supplies are limited, reuse strategies may be authorized
for some items of PPE that can be cleaned and/or disinfected for subsequent use
If the CDC issues guidance for Crisis Capacity Strategies, partner with your local public health department
and/or healthcare coalition for guidance on how this will be deployed at your facility
Extended use and limited reuse of single-use PPE items should only be done when the CDC issues guidance on
Expert tip: Crisis Capacity Strategies.
9.1.2021
�Long-Term Care
Personal Protective Equipment (PPE) Education
Knowledge
Utilization
Administration
Storing PPE
In order to maintain the quality of your PPE, it must be stored correctly to prevent it from being
damaged or succumbing to inadequate conditions.
Keep Storage areas:
• In compliance with regulatory requirements such as not storing items in external shipping boxes and
maintaining regulated distance from ceilings
• Environmentally controlled and free from dampness or risk of water damage
• Clean, tidy, and organized
Some Do's of PPE Storage:
• Store PPE separate from other items such as cleaning supplies, food, or equipment
• Keep stacks of PPE manageable, so they don't fall over
• Adhere to regulations pertaining to stacking height from floor and to ceiling
• Store boxes of PPE in a way that will not cause the weight to crush the boxes below
• Keep the PPE supply room clean, tidy, and organized with easy and safe access to all items
Expert tip: Rotate your stock to keep all PPE within its 'use by date’.
9.1.2021
Logistics
�Long-Term Care
Personal Protective Equipment (PPE) Education
Knowledge
Utilization
Administration
Logistics
Preparing for All Conditions
Maintain a PPE inventory that facilitates:
Normal daily use
• Normal daily consumption when caring for residents
• Training staff on how to use PPE correctly and in what situations it should be worn
• Performing annual respirator fit testing (understand that each fit test will use a respirator)
Be prepared to elevate PPE supply inventory:
• Know your vendors and their role when demand for PPE increases – ask about their allocation
strategy
Contingency planning
• Know your other sources for obtaining PPE, such as your local and state public health departments
and
• Know what PPE ensemble is required for the disease and route of transmission
situational awareness
• Prepare for CDC Crisis Capacity Strategies in which extended and limited reuse of PPE may be
required
• Consider potential substitutes such as using launderable versus disposable gowns, and prepare for
how they will be utilized and processed
Respond to periods in which PPE consumption increases due to:
Crisis response
• Local infectious disease outbreaks
• National infectious disease outbreaks
• International infectious disease outbreaks
Expert tip: During times of crisis, obtaining supplies may be limited due to demand – prepare, Prepare, PREPARE!
9.1.2021
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Guide
Document providing operation or response information, general guidance documents.
URL
https://repository.netecweb.org/files/theme_uploads/LTCPPEEducationFinalRev9.13.2021.pdf
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Long-Term Care: Personal Protective Equipment (PPE) Education
Subject
The topic of the resource
Infection Control
Description
An account of the resource
Welcome to NETEC education on Personal Protective Equipment (PPE) that has been developed specifically for Long-term Care (LTC) Facilities.<br /><br />The content in this education has been grouped into sections that will allow you to learn or refresh your knowledge on critical concepts of PPE management and use. You have the option of reviewing all or just the part of the content depending on your interest or need.<br /><br />Information in this downloadable PDF is targeted towards all professionals in LTC, from administration to the frontline workers.<br /><br />Download the optimized pdf above.<br />Download the <a href="https://repository.netecweb.org/files/theme_uploads/LTCPPEEducationFinalRev9.13.2021.pdf" target="_blank" rel="noreferrer noopener">full size pdf here</a>.
Creator
An entity primarily responsible for making the resource
NETEC
Date
A point or period of time associated with an event in the lifecycle of the resource
2021-09-01
Contributor
An entity responsible for making contributions to the resource
2023-07-13 by Christa Arguinchona and Caroline Croyle (PM) - Some items are covid specific in the document for csc, worth reviewing more regularly or adding a note to the asset saying this was built during covid with considerations for contingency and crisis capacities
2023-10-17 by Darrell, T&E group
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2026-10-18
Donning and Doffing
Face shield
Gloves
Goggles
Gown
Long-term Care
Mask
Masks
N95
Occupational Health
Personal Protective Equipment (PPE)
R-T&E
Staff Support
Staffing
Training
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Publication
A peer reviewed publication.
Citation
Citation information for the publication itself.
Toth, Damon J. A., Karim Khader, Alexander Beams, and Matthew H. Samore. 2019. "Model-based Assessment of the Effect of Contact Precautions Applied to Surveillance-detected Carriers of Carbapenemase-producing Enterobacteriaceae in Long-term Acute Care Hospitals." Clinical Infectious Diseases 69 (Supplement_3):S206-S13.
Abstract
<h2 class="abstract-title">Abstract</h2>
<div class="title">Background</div>
<p>An intervention that successfully reduced colonization and infection with carbapenemase-producing Enterobacteriaceae (CPE) in Chicago-area long-term acute-care hospitals included active surveillance and contact precautions. However, the specific effects of contact precautions applied to surveillance-detected carriers on patient-to-patient transmission are unknown, as other, concurrent intervention components or changes in facility patient dynamics also could have affected the observed outcomes.</p>
<div class="title">Methods</div>
<p>Using previously published data from before and after the CPE intervention, we designed a mathematical model with an explicit representation of postintervention surveillance. We estimated preintervention to postintervention changes of 3 parameters: <span class="inline-formula no-formula-id"><span class="MathJax" id="MathJax-Element-1-Frame"><span class="math" id="MathJax-Span-1" style="width:0.672em;"><span style="width:0.502em;height:0px;font-size:128%;"><span><span class="mrow" id="MathJax-Span-2"><span class="mstyle" id="MathJax-Span-3"><span class="mrow" id="MathJax-Span-4"><span class="mi" id="MathJax-Span-5" style="font-family:STIXGeneral;font-style:italic;">β<span style="height:1px;width:0.008em;"></span></span></span></span></span><span style="width:0px;height:2.567em;"></span></span></span><span style="vertical-align:-0.334em;border-left:0px solid;width:0px;height:1.273em;"></span></span></span></span><span class="inline-formula no-formula-id"></span>, the baseline transmission rate excluding contact precaution effects; <span class="inline-formula no-formula-id"><span class="MathJax" id="MathJax-Element-2-Frame"><span class="math" id="MathJax-Span-6" style="width:1.175em;"><span style="width:0.893em;height:0px;font-size:128%;"><span><span class="mrow" id="MathJax-Span-7"><span class="mstyle" id="MathJax-Span-8"><span class="mrow" id="MathJax-Span-9"><span class="mrow" id="MathJax-Span-10"><span class="msub" id="MathJax-Span-11"><span style="width:0.889em;height:0px;"><span><span class="mrow" id="MathJax-Span-12"><span class="mi" id="MathJax-Span-13" style="font-family:STIXGeneral;font-style:italic;">δ</span></span><span style="width:0px;height:4.018em;"></span></span><span><span class="mrow" id="MathJax-Span-14"><span class="mrow" id="MathJax-Span-15"><span class="mi" id="MathJax-Span-16" style="font-size:70.7%;font-family:STIXGeneral;">b</span></span></span><span style="width:0px;height:4.018em;"></span></span></span></span></span></span></span></span><span style="width:0px;height:2.288em;"></span></span></span><span style="vertical-align:-0.272em;border-left:0px solid;width:0px;height:1.199em;"></span></span></span></span><span class="inline-formula no-formula-id"></span>, the rate of a CPE carrier progressing to bacteremia; and <span class="inline-formula no-formula-id"><span class="MathJax" id="MathJax-Element-3-Frame"><span class="math" id="MathJax-Span-17" style="width:1.119em;"><span style="width:0.837em;height:0px;font-size:128%;"><span><span class="mrow" id="MathJax-Span-18"><span class="mstyle" id="MathJax-Span-19"><span class="mrow" id="MathJax-Span-20"><span class="mrow" id="MathJax-Span-21"><span class="msub" id="MathJax-Span-22"><span style="width:0.849em;height:0px;"><span><span class="mrow" id="MathJax-Span-23"><span class="mi" id="MathJax-Span-24" style="font-family:STIXGeneral;font-style:italic;">δ</span></span><span style="width:0px;height:4.018em;"></span></span><span><span class="mrow" id="MathJax-Span-25"><span class="mrow" id="MathJax-Span-26"><span class="mi" id="MathJax-Span-27" style="font-size:70.7%;font-family:STIXGeneral;">c</span></span></span><span style="width:0px;height:4.018em;"></span></span></span></span></span></span></span></span><span style="width:0px;height:2.288em;"></span></span></span><span style="vertical-align:-0.272em;border-left:0px solid;width:0px;height:1.199em;"></span></span></span></span><span class="inline-formula no-formula-id"></span>, the progression rate to nonbacteremia clinical detection.</p>
<div class="title">Results</div>
<p>Assuming that CPE carriers under contact precautions transmit carriage to other patients at half the rate of undetected carriers, the model produced no convincing evidence for a postintervention change in the baseline transmission rate <span class="inline-formula no-formula-id"><span class="MathJax" id="MathJax-Element-4-Frame"><span class="math" id="MathJax-Span-28" style="width:0.672em;"><span style="width:0.502em;height:0px;font-size:128%;"><span><span class="mrow" id="MathJax-Span-29"><span class="mstyle" id="MathJax-Span-30"><span class="mrow" id="MathJax-Span-31"><span class="mi" id="MathJax-Span-32" style="font-family:STIXGeneral;font-style:italic;">β <span style="height:1px;width:0.008em;"></span></span></span></span></span><span style="width:0px;height:2.567em;"></span></span></span><span style="vertical-align:-0.334em;border-left:0px solid;width:0px;height:1.273em;"></span></span></span></span>(+2.1% [95% confidence interval {CI}, −18% to +28%]). The model did find evidence of a postintervention decrease for <span class="inline-formula no-formula-id"><span class="MathJax" id="MathJax-Element-5-Frame"><span class="math" id="MathJax-Span-33" style="width:1.175em;"><span style="width:0.893em;height:0px;font-size:128%;"><span><span class="mrow" id="MathJax-Span-34"><span class="mstyle" id="MathJax-Span-35"><span class="mrow" id="MathJax-Span-36"><span class="mrow" id="MathJax-Span-37"><span class="msub" id="MathJax-Span-38"><span style="width:0.889em;height:0px;"><span><span class="mrow" id="MathJax-Span-39"><span class="mi" id="MathJax-Span-40" style="font-family:STIXGeneral;font-style:italic;">δ</span></span><span style="width:0px;height:4.018em;"></span></span><span><span class="mrow" id="MathJax-Span-41"><span class="mrow" id="MathJax-Span-42"><span class="mi" id="MathJax-Span-43" style="font-size:70.7%;font-family:STIXGeneral;">b</span></span></span><span style="width:0px;height:4.018em;"></span></span></span></span></span></span></span></span><span style="width:0px;height:2.288em;"></span></span></span><span style="vertical-align:-0.272em;border-left:0px solid;width:0px;height:1.199em;"></span></span></span></span><span class="inline-formula no-formula-id"></span>(−41% [95% CI, −60% to −18%]), but not for <span class="inline-formula no-formula-id"><span class="MathJax" id="MathJax-Element-6-Frame"><span class="math" id="MathJax-Span-44" style="width:1.119em;"><span style="width:0.837em;height:0px;font-size:128%;"><span><span class="mrow" id="MathJax-Span-45"><span class="mstyle" id="MathJax-Span-46"><span class="mrow" id="MathJax-Span-47"><span class="mrow" id="MathJax-Span-48"><span class="msub" id="MathJax-Span-49"><span style="width:0.849em;height:0px;"><span><span class="mrow" id="MathJax-Span-50"><span class="mi" id="MathJax-Span-51" style="font-family:STIXGeneral;font-style:italic;">δ</span></span><span style="width:0px;height:4.018em;"></span></span><span><span class="mrow" id="MathJax-Span-52"><span class="mrow" id="MathJax-Span-53"><span class="mi" id="MathJax-Span-54" style="font-size:70.7%;font-family:STIXGeneral;">c</span></span></span><span style="width:0px;height:4.018em;"></span></span></span></span></span></span></span></span><span style="width:0px;height:2.288em;"></span></span></span><span style="vertical-align:-0.272em;border-left:0px solid;width:0px;height:1.199em;"></span></span></span></span><span class="inline-formula no-formula-id"></span>(−7% [95% CI, −28% to +19%]).</p>
<div class="title">Conclusions</div>
<p>Our results suggest that contact precautions for surveillance-detected CPE carriers could potentially explain the observed decrease in colonization by itself, even under conservative assumptions for the effectiveness of those precautions for reducing cross-transmission. Other intervention components such as daily chlorhexidine gluconate bathing of all patients and hand-hygiene education and adherence monitoring may have contributed primarily to reducing rates of colonized patients progressing to bacteremia.</p>
<div class="article-metadata-panel clearfix">
<div class="kwd-group"><a class="kwd-part kwd-main">Keywords: contact precautions</a>, <a class="kwd-part kwd-main">carbapenem-resistant Enterobacteriaceae</a>, <a class="kwd-part kwd-main">transmission</a>, <a class="kwd-part kwd-main">active surveillance</a>, <a class="kwd-part kwd-main">mathematical model</a></div>
<div class="related-topic-tags">
<div class="related-topic-tag-label">Topic: <a><span>bacteremia, </span></a><a><span>disease transmission, </span></a><a><span>watchful waiting, </span></a><a><span>acute care, </span></a><a><span>contact precautions, </span></a><a><span>surveillance, medical, </span></a><a><span>microbial colonization, </span></a><a><span>mathematical model, </span></a><a><span>carbapenem-resistant enterobacteriaceae</span></a></div>
</div>
<div class="article-metadata-tocSections">
<div class="article-metadata-tocSections-title"><a>Issue Section: </a><a>supplement articles</a></div>
</div>
</div>
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
Online with journal subscription (Oxford Academic).
URL
https://www.ncbi.nlm.nih.gov/pubmed/31517974
Read Online
Online location of the resource.
https://academic.oup.com/cid/article/69/Supplement_3/S206/5568512
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Model-based Assessment of the Effect of Contact Precautions Applied to Surveillance-detected Carriers of Carbapenemase-producing Enterobacteriaceae in Long-term Acute Care Hospitals
Subject
The topic of the resource
Infection Control
Description
An account of the resource
An intervention that successfully reduced colonization and infection with carbapenemase-producing Enterobacteriaceae (CPE) in Chicago-area long-term acute-care hospitals included active surveillance and contact precautions.
Creator
An entity primarily responsible for making the resource
C. D. C. Prevention Epicenters Program and C. D. C. Modeling Infectious Diseases in Healthcare Program (CDC)
Source
A related resource from which the described resource is derived
Toth, Damon J. A., Karim Khader, Alexander Beams, and Matthew H. Samore.
Date
A point or period of time associated with an event in the lifecycle of the resource
2019-10-01
Type
The nature or genre of the resource
Publication
Contributor
An entity responsible for making contributions to the resource
2022-01-10 by PPE group Shawn Gibbs
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-01-10
Contact Transmission
Long-term Care
Personal Protective Equipment (PPE)
R-LTC
R-PPE
R-Res&Pub
-
https://repository.netecweb.org/files/original/68192d414875871a2a84b69f2b25206d.pdf
d27f380701da1442b74bd16044f80dff
PDF Text
Text
NETEC COVID-19 Webinar Series:
Long Term Care: Strategies to
Care for Vulnerable Populations
�Content Outline (TOC)
Welcome
Shelly Schwedhelm, MSN, RN, NEA-BC
�Overview
Welcome: Shelly Schwedhelm, MSN, RN, NEA-BC
A Review of Basics and Case Review: Jill Morgan, RN, BSN
Trish Tennill, RN, BSN
COVID-19 Experiences and Guidance in Nebraska
Post-Acute and Long-Term Care: Muhammed Salman Ashraf, MBBS
Kate Tyner, RN, BSN, CIC
NETEC Resources: Shelly Schwedhelm, MSN, RN, NEA-BC
Questions and Answers with NETEC
�Welcome
National Emerging Special Pathogens
Training and Education Center
Mission Statement
To increase the capability of the United States public health and
health care systems to safely and effectively manage individuals
with suspected and confirmed special pathogens
For more information
Please visit us at www.netec.org
or email us at info@netec.org
�NETEC Overview
Assessment
Education
Technical Assistance
Research Network
Empower hospitals to gauge
their readiness using
Provide self-paced education
through
Onsite & Remote
Guidance
Online Repository
Self-Assessment
Measure facility and
healthcare worker readiness
using
Metrics
Meet Fred
Online Trainings
Compile
Online Repository
Deliver didactic and hands-on
simulation training via
In-Person Courses
of tools and resources
Develop customizable
Exercise Templates
based on the HSEEP model
Provide direct feedback to
hospitals via
On-Site Assessment
COVID-19 focused
Webinars
Provide
Emergency On-Call
Mobilization
Cross-Cutting, Supportive Activities
Built for rapid implementation
of clinical research protocols
Develop Policies,
Procedures and Data
Capture Tools
to facilitate research
Create infrastructure for a
Specimen
Biorepository
�Content Outline (TOC)
A Review of Basics and Case Review
Jill Morgan, RN, BSN
Trish Tennill, RN, BSN
�Source Control and Infection Prevention
Source Control First
Patients, residents and staff can wear masks as SOURCE CONTROL
– to limit circulation of what we exhale and cough
Staff, residents and patients should all perform hand hygiene frequently
– especially after touching clients, surfaces or PPE
�Source Control and Infection Prevention
Symptom Screening
One of the difficulties of the current outbreak is the potential for ‘asymptomatic spread’
People who feel fine, with no fever, cough or other symptoms,
who are carrying - and perhaps spreading - the disease
Current symptoms to watch for include:
•
•
•
•
•
Fever
Cough
Muscle Pain
Shortness of breath, trouble breathing
Chills
•
•
•
•
•
Shaking chills (rigors)
Headache
Sore throat
Loss of taste or smell
Rash?
�Source Control and Infection Prevention
The Purpose of Personal Protective Equipment (PPE)
Pathogens need a way into the body
Primarily, these diseases enter the body through the eyes, nose and mouth
Goggles, safety glasses or face shield – eyeglasses do not count! If you are near people
who are coughing (within arm’s length), try to protect your eyes
Mask and respirators - prevents coughs, sneezes, and sprays from entering mucous
membranes
Gown and gloves - keep hands and clothing clean, which helps prevent germs from
accidently entering the eyes, nose and mouth after doffing PPE
�Hierarchy of Controls
MOST
EFFECTIVE
ELIMINATION
PHYSICALLY REMOVE
THE HAZARD
SUBSTITUTION
REPLACE
THE HAZARD
ENGINEERING
CONTROLS
ISOLATE PEOPLE
FROM THE HAZARD
ADMINISTRATIVE
CONTROLS
CHANGE THE WAY
PEOPLE WORK
PPE
PROTECT THE
WORKER WITH PPE
LEAST
EFFECTIVE
https://www.cdc.gov/niosh/topics/hierarchy/default.html
�Case Study One
Situation
Geneva is 83 and has lived at Manor Square for 3 years. She is accustomed to taking her meals in the
dining room and walks the length of the interior corridors for her daily exercise, visiting with her hallway
neighbors. She is generally self-sufficient, uses rails always and a walker occasionally. She only needs
assistance when showering. She speaks with her family by phone once a week and her daughter Amanda
visits her every Friday and takes her out to dinner
Manor Square has not had any COVID-19 cases to date, they are unable to test residents, testing is
performed at a local hospital and only on symptomatic patients
Geneva now has had decreased appetite, poor p.o. intake and is spending more time in bed. Staff now
have to assist her OOB to chair for meals. She initially complained about her walking restrictions, but
now appears depressed
Identify the Hazard
Asymptomatic spread means residents and staff are at risk of both spreading the virus and becoming ill
Secondary hazards – social isolation, depression, failure to thrive, deconditioning
�Case Study One
Situation
Identify
the hazard
• Geneva is 83 and has lived at Manor Square for 3 years. She is accustomed to taking her meals in the dining room and walks the length of
the interior corridors for her daily exercise, visiting with her hallway neighbors. She is generally self-sufficient, uses rails always and a
walker occasionally. She only needs assistance with showering. She speaks with her family by phone once a week and her daughter
Amanda visits her every Friday and takes her out to dinner.
• Manor Square has not had any COIVD cases to date, they are unable to test residents, testing is performed at a local hospital and only on
symptomatic patients.
•
Asymptomatic spread means residents and staff are at risk of both spreading and becoming ill
Engineering Controls
Most effective
•
•
•
•
Least effective
Air Circulation
Barriers to prevent transmission
Physical Distancing
Cohorting residents in zones
�Case Study One
Situation
Identify
the hazard
Most effective
Least effective
• Geneva is 83 and has lived at Manor Square for 3 years. She is accustomed to taking her meals in the dining room and walks the length of
the interior corridors for her daily exercise, visiting with her hallway neighbors. She is generally self-sufficient, uses rails always and a
walker occasionally. She only needs assistance with showering. She speaks with her family by phone once a week and her daughter
Amanda visits her every Friday and takes her out to dinner.
• Manor Square has not had any COIVD cases to date, they are unable to test residents, testing is performed at a local hospital and only on
symptomatic patients.
•
Asymptomatic spread means residents and staff are at risk of both spreading and becoming ill
Administrative Controls
Administrative
Develop protocols
that direct: Controls
• Movement restrictions within the facility
• Monitoring staff and residents for signs and symptoms
• Visitation restrictions
• Outside medical appointments
• Resident meals
• Communication strategies
• Equipment use
• PPE donning, doffing and supply management
• Environmental cleaning strategies
�Case Study One
Situation
Identify
the hazard
Most effective
• Geneva is 83 and has lived at Manor Square for 3 years. She is accustomed to taking her meals in the dining room and walks the length of
the interior corridors for her daily exercise, visiting with her hallway neighbors. She is generally self-sufficient, uses rails always and a
walker occasionally. She only needs assistance with showering. She speaks with her family by phone once a week and her daughter
Amanda visits her every Friday and takes her out to dinner.
• Manor Square has not had any COIVD cases to date, they are unable to test residents, testing is performed at a local hospital and only on
symptomatic patients.
•
Asymptomatic spread means residents and staff are at risk of both spreading and becoming ill
Administrative Controls
Staffing Protocols:
• Staff assignments
• Staff training requirements
• Workflows
• PPE
• Role expansion for staff (within scope of practice)
Least effective
�Case Study One
Situation
Identify
the hazard
• Geneva is 83 and has lived at Manor Square for 3 years. She is accustomed to taking her meals in the dining room and walks the length of
the interior corridors for her daily exercise, visiting with her hallway neighbors. She is generally self-sufficient, uses rails always and a
walker occasionally. She only needs assistance with showering. She speaks with her family by phone once a week and her daughter
Amanda visits her every Friday and takes her out to dinner.
• Manor Square has not had any COIVD cases to date, they are unable to test residents, testing is performed at a local hospital and only on
symptomatic patients.
•
Asymptomatic spread means residents and staff are at risk of both spreading and becoming ill
PPE
Most effective
•
•
•
•
Least effective
CDC guidance:
Preferred vs acceptable
Universal masking
Hand hygiene
• Technique
• Supplies
Training and Competency is ESSENTIAL
�Case Study One
Questions for Case Study One
1. What strategies can be used to minimize disruption to well residents/patients?
2. What actions can be taken to ensure nutrition, hydration and toileting schedules remain intact?
3. What impact do changes such as closed doors, in-room dining, decreased socialization of residents and
increased demand for staff attention have?
4. What are some best practice ideas for maintaining communication between residents/patients and
families?
5. Have you seen detrimental effects of social isolation with your residents? How have you intervened
successfully?
6. Should long term care facilities routinely test residents regardless of symptoms?
7. Are new resident admissions tested and sequestered? For how long?
8. What about residents who travel outside the facility for appointments?
9. And about residents who may be admitted to an acute care setting for a non-COVID related complaint?
�Case Study Two
Situation
John Henry is 73 and is recovering from a right BKA. He is receiving PT/OT and leaves Manor
Square every T-TH-S for a 3 - 4 hour dialysis session. The facility has a transport van that takes
John Henry and another resident for these occasions, and they have been moved to a semiprivate room together
While the initial goal for rehab was for John Henry to return home, he is not meeting his
goals secondary to weakness and failure to thrive. Manor Square has a separate wing for
rehab distinct from its skilled nursing units, necessitating a room change if John Henry
does not achieve his rehab goals
Identify the Hazard
Asymptomatic spread
Transmission during transport or dialysis
Secondary hazards: Throughputs to LTC and acute care settings, failure to thrive
�Case Study Two
•
Situation
Identify
the hazard
Most effective
•
•
•
John Henry is 73 and is recovering from a right BKA. He is receiving PT/OT and leaves Manor Square every T-TH-S for a 3-4 hour dialysis
session. The facility has a transport van that takes John Henry and another resident for these occasions, and they have been moved to a
semi-private room together
While the initial goal for rehab was for John Henry to return home, he is not meeting his goals secondary to weakness and failure to
thrive. Manor Square has a separate wing for rehab distinct from its skilled nursing units, necessitating a room change if John Henry
does not achieve his rehab goals
Asymptomatic spread
Transmission during transport or dialysis
•
•
Throughputs to LTC and acute care settings
Failure to thrive
Engineering Controls
• Increase outside air circulation
• Create barriers between workstations for staff
• Create physical barriers that allow communication, visual access
between staff and residents at nursing stations
Least effective
�Case Study Two
•
Situation
Identify
the hazard
Most effective
•
•
•
John Henry is 73 and is recovering from a right BKA. He is receiving PT/OT and leaves Manor Square every T-TH-S for a 3-4 hour dialysis
session. The facility has a transport van that takes John Henry and another resident for these occasions, and they have been moved to a
semi-private room together
While the initial goal for rehab was for John Henry to return home, he is not meeting his goals secondary to weakness and failure to
thrive. Manor Square has a separate wing for rehab distinct from its skilled nursing units, necessitating a room change if John Henry
does not achieve his rehab goals
Asymptomatic spread
Transmission during transport or dialysis
•
•
Throughputs to LTC and acute care settings
Failure to thrive
Administrative Controls
Develop Protocols to direct:
• The decontamination of transport devices and vehicles
• Distancing passengers, wearing facemasks
• Cohorting by exposure risk
Least effective
�Case Study Two
•
Situation
Identify
the hazard
Most effective
•
•
•
John Henry is 73 and is recovering from a right BKA. He is receiving PT/OT and leaves Manor Square every T-TH-S for a 3-4 hour dialysis
session. The facility has a transport van that takes John Henry and another resident for these occasions, and they have been moved to a
semi-private room together
While the initial goal for rehab was for John Henry to return home, he is not meeting his goals secondary to weakness and failure to
thrive. Manor Square has a separate wing for rehab distinct from its skilled nursing units, necessitating a room change if John Henry
does not achieve his rehab goals
Asymptomatic spread
Transmission during transport or dialysis
•
•
Throughputs to LTC and acute care settings
Failure to thrive
PPE
• Implement PPE use when clients are anywhere outside of their
own room
• Meticulous and frequent hand hygiene
• PPE available, staff trained in each ensemble
Least effective
�Case Study Two
Questions from Case Two
1. What strategies can facilities use to make transport safer for residents and staff?
2. What should LTC facilities ask of dialysis centers and other referral sites?
3. What infection prevention measures should be taken in regard to the transport van,
4. The driver/assistant, the resident/patients, and the staff who send and receive
resident/patients?
5. Are high, or higher risk residents managed in a separate area, or by different staff? When
would that be appropriate, if ever?
6. Is symptom and vital sign monitoring done with the same frequency for all residents?
7. How are rehab therapies (PT, OT, speech) affected at your facility? What strategies have been
successful in maintaining forward momentum for resident/patients?
8. What are the advantages and disadvantages of moving resident/patients together by risk level?
�Strategies
1. Rapid-Hire Center – targeting service industry workers who are now un- or underemployed,
utilizing the temporary waiver for certification (42 CFR 483.35(d)), with the goal of
permanent career change
2. Use of walking virtual tours via web-meeting platforms to allow for PH evaluations of
building interventions (air handling, portable filtration, temporary walls/partitions)
3. Trending of resident vital signs to monitor for changes prior to development of clinical fever,
trends identified trigger increased monitoring frequency and the addition of physical
assessments
4. Administrative 24h call center – to respond to the higher-level inquiries about cases, plans,
interventions and strategies, to relieve facility staff from the duty to answer those questions
5. Scheduled based on family preference for timing and frequency, video chat calls from
resident/patient rooms with staff assistance, question answering
�Content Outline (TOC)
COVID-19 Experiences and Guidance in
Nebraska Post-Acute and Long-Term Care
Muhammad Salman Ashraf, MBBS
Kate Tyner, RN, BSN, CIC
�COVID-19 Experiences and Guidance in
Nebraska Post-Acute and Long-Term Care
Nebraska Post-Acute and Long-Term Care
COVID-19 Programmatic Elements
Weekly Educational Webinars with significant time devoted to question and answer
• Include panelists from various stakeholder organizations
• Use DHHS inventory of facilities and contacts to distribute call information
• Post invitation, slides, and transcript from each week
Daily “Office Hours” staffed by infection preventionists
CDC Tele-ICAR assessments and feedback
On-site NETEC technical support visits
Weekly calls hosted by DHHS Regulatory Division to provide updates on tracking,
reporting, and CMS guidance
One-to-one mentoring calls to facilities with COVID-19 cases
�COVID-19 Experiences and Guidance in
Nebraska Post-Acute and Long-Term Care
CDC Tele-ICAR Findings in Nebraska: Regarding PPE
Concerns
Suggestions
•
•
•
•
•
disposable gowns being reused
Severe shortage of PPE noted in one facility
Healthcare workers not wearing facemasks appropriately and at all times
Cloth facemasks in use by healthcare workers with resident contact
Facemasks being touched while in use
• Assess PPE supplies and plan contingency strategies for shortages
• Prioritize use of full PPE when supplies are limited – optimize usage
• Suggest use of cloth masks for essential visitors and healthcare workers
who do not have direct resident care activities.
• Observations/audits of PPE use – donning/doffing document
and give feedback
�COVID-19 Experiences and Guidance in
Nebraska Post-Acute and Long-Term Care
CDC Tele-ICAR Findings in Nebraska
Hand Hygiene Concern
• Insufficient access to alcohol-based hand sanitizer
Hand Hygiene Suggestions:
• Suggest auditing/monitoring use of hand hygiene practices
• Use alcohol-based hand rub preferentially over handwashing
Environmental Cleaning Concerns
• Cleaning products in use that aren’t on the EPA List N (approved agent against SARS-CoV-2)
Environmental Cleaning Suggestions:
• Ensure disinfectants are being used at correct dilution/mixing
• Ensure those mixing and using chemicals wear appropriate PPE
• Develop schedule for regular cleaning and disinfection of shared equipment/areas.
• Audit cleaning processes
�COVID-19 Experiences and Guidance in
Nebraska Post-Acute and Long-Term Care
CDC Tele-ICAR Findings in Nebraska
Transmission risks Concerns:
• Residents not being monitored at least three times daily for signs/symptoms of illness
• Screening not expanded to look for all 19 COVID-19 symptoms now identified (atypical presentations)
• Lack plan for managing admissions/readmissions of persons whose COVID-19 status is unknown
Suggestions for decreasing transmission risk:
• Dedicate an area of the facility to care for residents with confirmed COVID-19
• Assign dedicated healthcare workers to only the area of the facility where COVID-19 positive residents are housed
• Place signage at entrance to the cohort units to instruct workers on using PPE in that area
• Encourage all residents to remain in their room if there are COVID-19 cases in the community or facility
•
Develop zone for observation/isolation of new admissions/persons exposed to COVID-19; implement testing at
end of 14 days to be sure residents are not infected
Testing for COVID
•
Discuss with ICAP regarding the need for expanded testing of resident and staff upon identification of a resident
with COVID-19
�NETEC Technical Consultations: The Gap
Development of Standard
Operating Procedures
Execution of Standard
Operating Procedures
�Thematic Summary of Findings (N=16)
Strengths
• General IPC
•Restriction of entrance to only one general entrance
•Engagement of leadership staff and enthusiasm to advance preparedness
•Universal masking early for all staff
•Restriction of visitors, volunteers and non-essential personnel
•Just in time training plans for staff members in IPC –hand hygiene and PPE use
•Screening and Monitoring
•Increased frequency of resident monitoring for temperature and s/s
•Staff screening at entrance prior to starting shift
•PPE
•Working with local and state resources to try and source some type of PPE*
•Have established donning/doffing protocols
•Resident Placement
•Preparedness plans incorporate zoning to include Red, Yellow, Green and Gray
•Attempts to dedicate staff to each zone in place
•Use of CDC guidance to develop discontinuation of isolation
�Thematic Summary of Findings (N=16)
Challenges
• General IPC
•Inadequate supplies of hand sanitizer and
disinfectant wipes
•Lack of compliance to frequency of hand
hygiene
•Increased need for education on disinfectant
use-contact times
•Need for hands on training for all employees
•Resident Placement
•Fans still in use and windows being opened
in yellow and red zones
•Residents not able to tolerate masking
•Doors not able to remain shut despite
protocols-fall risks and dementia
•PPE
•Limited access to adequate supplies
•N95s donated but very few facilities have
ability to fit test
•Lack of awareness of local and state PPE
request processes
•Staff ability to don and doff PPE in
accordance with protocols is inconsistent
•PPE not able to be stored in optimal ways
•“PPE fatigue” decreasing compliance with
leaving procedure masks in place at all times
�COVID-19 Experiences and Guidance in
Nebraska Post-Acute and Long-Term Care
Appropriate PPE Attire
IMPORTANT
Masks should be medical grade and
post-acute/ long term care facility staff
should not be wearing cloth masks
https://www.cdc.gov/coronavirus/2019-ncov/downloads/A_FS_HCP_COVID19_PPE.pdf.
�COVID-19 Experiences and Guidance in
Nebraska Post-Acute and Long-Term Care
What Mask?
D
wa on’t
sh for
clo get
th
ma to
sks
!
Source Control: Non-Clinical Staff
For example, visitors
Patient care PPE
�COVID-19 Experiences and Guidance in
Nebraska Post-Acute and Long-Term Care
CDC on Homemade Cloth Face Coverings
Wear cloth face coverings in public settings where other social distancing
measures are difficult to maintain (e.g., grocery stores and pharmacies)
Use of simple cloth face coverings to slow the spread of the virus
Help people who may have the virus and do not know it from transmitting
it to others
The cloth face coverings recommended are not surgical masks or N-95
respirators
https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/cloth-face-cover.html
�Leading Age Nebraska
www.leadingagene.org
Transfer Assessment
Flow Chart
�COVID-19 Experiences and Guidance in
Nebraska Post-Acute and Long-Term Care
Actions to be taken upon identification of a COVID-19
case at a post-acute/ long-term care facility
• Notification
• Isolation and Quarantine
• Including cohorting guidance
• Steps to take if a staff member or resident is identified to have COVID-19
• Testing
• Use of Personal Protective Equipment (PPE)
• Additional Infection Prevention and Control Measures
https://icap.nebraskamed.com/wp-content/uploads/sites/2/2020/04/Actions-needed-to-be-taken-upon-identification-of-a-COVID-19-case.pdf
��COVID-19 Experiences and Guidance in
Nebraska Post-Acute and Long-Term Care
Nebraska ICAP COVID-19 Cohorting Guidance to LTCF
All LTCF should implement a cohorting plan when a case of COVID-infected is suspected
or identified in the facility
The facilities should plan to identify red, yellow and green zones where the residents can
be cohorted based on their symptoms and exposure risks to COVID-19
Facilities are also recommended to establish a transitional zone (gray zone) for
asymptomatic patients who are being transferred from other healthcare facility
https://icap.nebraskamed.com/wp-content/uploads/sites/2/2020/04/Cohorting-Plan-for-LTCF-4.17.20.pdf
�COVID-19 Experiences and Guidance in
Nebraska Post-Acute and Long-Term Care
Defining Zones for Cohorting Residents with COVID-19 in LTCF
Red Zone Dark Red
(Isolation zone) Light Red
Yellow Zone (Quarantine zone)
Green Zone (COVID-19 free zone)
Gray Zone (Transitional zone)
Residents with Positive COVID-19 test
Symptomatic residents suspected of having COVID-19
Asymptomatic residents who may have been exposed to
COVID-19
Asymptomatic residents without any exposure to
COVID-19
Residents who are being transferred from the
hospital/outside facilities (but have no known exposure
to COVID-19) are usually kept in this zone for 14 days
and if remains asymptomatic at the end of 14 day will
be moved to Green zone
https://icap.nebraskamed.com/wp-content/uploads/sites/2/2020/04/Cohorting-Plan-for-LTCF-4.17.20.pdf
�COVID-19 Experiences and Guidance in
Nebraska Post-Acute and Long-Term Care
Red (Isolation) Zone
All residents who have tested positive for COVID-19 (Dark Red Zone)
All residents who are symptomatic and suspected to have COVID-19 even if the test
results are not back (Light Red Zone)
Cohort confirmed positive (dark red) and suspected positive (light red) separately
within the Red Zone
Dedicate separate healthcare personnel to work in Red Zone and preferably assign
separate healthcare personnel to dark and light red zone, if possible
Healthcare workers should wear full COVID-19 level PPE (Gloves, Gown, Mask and
eye protection) when taking care of these patients
Refer to the PPE guidance for detail https://icap.nebraskamed.com/wp-content/uploads/sites/2/2020/04/PPE-use-when-a-LTCF-has-a-COVID-19-infection-ICAP-guidance-4.16.2020.pdf
�COVID-19 Experiences and Guidance in
Nebraska Post-Acute and Long-Term Care
Yellow (Quarantine) Zone
All asymptomatic residents who may have been exposed to COVID-19
Several factors have to be taken into consideration in order to determine the risk of exposures. These
factors include (but are not limited to):
• Suspected mode of COVID-19 acquisition (for the positive resident)
• Movement of resident with COVID-19 infection within the facility prior to the diagnosis
• Facilities policies on universal masking and visitation
• Compliance of staff with infection control protocols
• Number of residents with suspected or confirmed COVID-19 infection in a unit
Examples of residents who may qualify for being in yellow zones:
• All asymptomatic residents of a single unit/hallway/neighborhood where a few residents are
symptomatic, and one has already tested positive for COVID-19
• All asymptomatic residents of a facility where a staff member who tested positive for COVID-19 has
worked while having symptoms and multiple residents in various units are now symptomatic
�COVID-19 Experiences and Guidance in
Nebraska Post-Acute and Long-Term Care
Yellow (Quarantine) Zone: PPE Guidance
All residents in the yellow zone should be in isolation and healthcare workers should wear COVID-level
PPE to take care of these residents.
When PPE supply is inadequate, facility may follow CDC’s extended use/limited reuse PPE protocols for
taking care of all residents in yellow zone.
If gowns are in short supply, one option to conserve gowns can be to limit its use for following:
• During care activities where splashes and sprays are anticipated, which typically includes aerosolgenerating procedures (such as nebulization, suction etc.)
• During high-contact patient care activities such as dressing, bathing/showering, transferring,
providing hygiene, changing linens, changing briefs or assisting with toileting, device care or use,
wound care.
https://www.cdc.gov/niosh/topics/hcwcontrols/recommendedguidanceextuse.html
https://med.emory.edu/departments/medicine/divisions/infectious-diseases/seriouscommunicable-diseases-program/covid-19-resources/conserving-ppe.html
https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/isolation-gowns.html
�COVID-19 Experiences and Guidance in
Nebraska Post-Acute and Long-Term Care
Green (COVID-FREE) Zone
All asymptomatic residents who are not considered to be exposed will be in green zone
Examples of residents belonging to green zone:
• All asymptomatic residents residing in a unit/hallway/neighborhood where no symptomatic
residents have been identified and which is distinctly separated from those
unit/hallway/neighborhood where residents have or suspected to have COVID-19
• All asymptomatic residents in the facility where a COVID-19 case is identified in a resident
who was recently admitted from the hospital and has been in quarantine since admission
(with staff wearing full COVID-level PPE with all interactions)
If there are symptomatic residents suspected of having COVID-19 in many different
units/hallway/neighborhood, then there may not be a green zone in that nursing home (at least at
that point in time), as everyone is going to be considered exposed
�Example of a floor plan with:
Red Zones
Green Zones
zones
�COVID-19 Experiences and Guidance in
Nebraska Post-Acute and Long-Term Care
Strategies for Establishing Red, Yellow & Green Zones
If nursing home has space/rooms available then it will be preferred to establish red, yellow and green zones in
geographically distinct areas within the nursing homes
• For example, if a facility has an empty unit, then the symptomatic/COVID-19 positive residents will be
transferred immediately to that area for isolation, which will be considered the red zone
• The unit from where the residents were moved from will now be considered a yellow zone. The rest of the
facility will be considered a green zone
If space is limited, red and yellow zones can be established within the same unit/hallway/neighborhood
• For example, when a resident is diagnosed with COVID-19 infection and there is no isolation area available in
the facility, the resident room will be considered the red zone and the resident will stay in his/her own room
• The rest of the unit will become the yellow zone. All other units in the facility will be considered a green zone if
it is established that residents in those units have not been exposed
• If the resident in the above example have a roommate. The roommate should be transferred to a private room
within the yellow zone. (Note: Do not transfer the roommate to green zone)
�COVID-19 Experiences and Guidance in
Nebraska Post-Acute and Long-Term Care
Strategies for Establishing Red, Yellow & Green Zones
If COVID-19 cases are identified in more than one units/hallway/neighborhood, then some of those can become red
zone and others yellow zone.
• Example scenario: COVID-19 cases are identified in both north and south hallways and there are additional
symptomatic residents residing in those hallways for whom testing is being performed.
• Move all COVID-19 positive and symptomatic residents in one hallway (cohort confirmed positive residents
at one end of that hallway and suspected positive at other end). This will be considered the red zone
(including both dark red and light red zone).
• Move all asymptomatic residents to the other hallway, which will now be considered a yellow zone.
• If the facility has additional hallways or units that are geographically distinct from the north and south
hallway (and no exposure is suspected), then those units/hallways will be considered the green zone.
However, if everyone is considered exposed then there is no true green zone in the facility at that point.
�COVID-19 Experiences and Guidance in
Nebraska Post-Acute and Long-Term Care
Staffing Strategies for Red, Yellow & Green Zones
Ideally, all zones (including dark and light red zones) should have dedicated staff. However, majority of
the nursing homes will not have the capacity to dedicate staff for each zones. Following rules can be
applied for dedicating staff to different zones including when staffing is limited.
Dedicating staff to the red zone (preferably separate for dark and light red) is recommended, whenever
possible.
Nursing homes should consider avoiding assigning those staff who are working in the red or yellow
zones to the green or gray zone to the extent possible.
However, if the facility is making a tough choice that in order to staff a yellow zone, they either have to
pull HCW from the green zone or red zone, it will be preferred to assign the red zone staff to cover the
yellow zone too.
If staff has to work in multiple zones, it will be preferred that they plan ahead and batch all the caregiving activities together in a way that they finish the work in one zone, to the extent possible, before
moving on to the next zone. Follow infection prevention and control procedures very strictly to avoid
transmission between zones.
�COVID-19 Experiences and Guidance in
Nebraska Post-Acute and Long-Term Care
Gray (Transitional) Zones
All nursing homes should consider establishing a transitional zone for new admissions, returning
residents from the hospital or those who are travelling in and out of the nursing home (such as the
residents who are on dialysis). Transitional zones/units are established to quarantine those residents who
are at somewhat higher risk of getting exposed to COVID-19 but have no known exposure to COVID-19
• Facilities should also consider dedicating separate staff to take care of residents in transitional
(gray) zone/unit
• Facilities may consider implementing COVID-level precautions for the residents admitted to the
transition unit based on individual risk assessment
• These units should be established even when no COVID-case is identified at the facility and may
consist of dedicating a geographically distinct area/unit/rooms to returning residents
• The residents are usually kept in this zone for 14 days and if remains asymptomatic at the end of
14 day will be moved to the Green zone
�Content Outline (TOC)
NETEC Resources
Shelly Schwedhelm, MSN, RN, NEA-BC
�Resources: NETEC
NETEC is Here to Help
NETEC will continue to build resources, develop online education,
and deliver technical training to meet the needs of our partners
Ask for help!
Send questions to info@netec.org - they will be answered by NETEC SMEs
Submit a Technical Assistance request at NETEC.org
�Questions
and
Answers
�Contact
NETEC eLearning Center
NETEC Skill videos
courses.netec.org
youtube.com/thenetec
Join the Conversation!
@theNETEC
@the_NETEC
Use hashtag: #NETEC
Website
Repository
Email
netec.org
repository.netecweb.org
info@netec.org
��
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Title
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Deploy
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Webinar
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Friday, May 8, 2020 | 1:00 PM CST
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https://youtu.be/W9nxNaYiKP8
Player
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<br /><iframe width="560" height="315" title="Long Term Care webinar" src="https://www.youtube.com/embed/W9nxNaYiKP8?autoplay=0" frameborder="0"></iframe>
Alternate URL
Other URLs if necessary.
CEU online course: <a href="https://courses.netec.org/courses/20-web-ltcstrat" target="_blank" rel="noreferrer noopener">https://courses.netec.org/courses/20-web-ltcstrat</a>
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Self-paced, 1 credit
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NETEC COVID-19 Webinar Series (5/8/20)/Online Course: Long Term Care: Strategies to Care for Vulnerable Populations
Subject
The topic of the resource
Treatment & Care
Description
An account of the resource
Identifying strategies and innovative practices for the identification and management of COVID19 patients and for safe continuity of care for all.<br /><br />Webinar slides attached.<br />
<h2>Get educational credit for this webinar through <a href="https://courses.netec.org/courses/20-web-ltcstrat" target="_blank" rel="noreferrer noopener">Courses.netec.org</a>.</h2>
Creator
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NETEC
Date
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2020-05-08
Type
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Webinar and Online Course
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-01-01
2019-nCoV
CEU
CEUs
Coronavirus
COVID-19
Long-term Care
Online Course
R-LTC
-
https://repository.netecweb.org/files/original/cfcfc8e12b5097b1c81ee412a23fda8d.pdf
001e540a2ae03a7a91aae0d27160aec8
PDF Text
Text
NETEC COVID-19 Webinar Series:
Environmental Cleaning
and
Infection Prevention
�Content Outline (TOC)
Welcome
Sharon Vanairsdale, DNP, APRN, ACNS-BC, NP-C, CEN, FAEN, FAAN
�Overview
Welcome: Sharon Vanairsdale, DNP, APRN, ACNS-BC, NP-C, CEN, FAEN, FAAN
Basic Principles of Contact Transmission and the Role of LowLevel Disinfectants, Cleaning and Disinfection: Terry Micheels, MSN, RN, CIC, FAPIC
Environmental Cleaning and Disinfection of Surfaces in the
Context of COVID-19: Kari L Love, MS, RN, CIC, FAPIC
Environmental Cleaning Challenges and Strategies in PostAcute and Long-Term Care : Kate Tyner, BSN, RN, CIC
NETEC Resources: Sharon Vanairsdale, DNP, APRN, ACNS-BC, NP-C, CEN, FAEN, FAAN
Questions and Answers with NETEC
�Welcome
National Emerging Special Pathogens
Training and Education Center
Mission Statement
To increase the capability of the United States public health and
health care systems to safely and effectively manage individuals
with suspected and confirmed special pathogens
For more information
Please visit us at www.netec.org
or email us at info@netec.org
�NETEC Overview
Assessment
Education
Technical Assistance
Research Network
Empower hospitals to gauge
their readiness using
Provide self-paced education
through
Onsite & Remote
Guidance
Online Repository
Self-Assessment
Measure facility and
healthcare worker readiness
using
Metrics
Meet Fred
Online Trainings
Compile
Online Repository
Deliver didactic and hands-on
simulation training via
In-Person Courses
of tools and resources
Develop customizable
Exercise Templates
based on the HSEEP model
Provide direct feedback to
hospitals via
On-Site Assessment
COVID-19 focused
Webinars
Provide
Emergency On-Call
Mobilization
Cross-Cutting, Supportive Activities
Built for rapid implementation
of clinical research protocols
Develop Policies,
Procedures and Data
Capture Tools
to facilitate research
Create infrastructure for a
Specimen
Biorepository
�Content Outline (TOC)
Basic Principles of Contact Transmission
and the Role of Low-Level Disinfectants,
Cleaning and Disinfection
Terry Micheels, MSN, RN, CIC, FAPIC
�Basic Principles of Contact Transmission and the Role of
Low-Level Disinfectants, Cleaning and Disinfection
Principles of Transmission
Chain of Infection
Interrupting the pathogen source
and
Mode of Transmission
Image Credit: NIAID - Colorized scanning electron micrograph of an apoptotic cell (greenish brown) heavily infected with SARS-COV-2 virus particles (pink), isolated from a patient sample
�Basic Principles of Contact Transmission and the Role of
Low-Level Disinfectants, Cleaning and Disinfection
Break the Chain
Environmental factors play a role in the transmission of microorganisms
• Stop transmission by eliminating
• Source of infectious agents
• Means of Transmission
• Environmental sources
• Used patient equipment
• Patient bed and furniture
• Environmental surroundings
• Sinks, basins
�Basic Principles of Contact Transmission and the Role of
Low-Level Disinfectants, Cleaning and Disinfection
Direct and Indirect Routes of Contact Transmission
�Surface Contamination
Microorganisms persist on environmental surfaces
Coronaviruses are enveloped, singlestranded, positive-stranded RNA viruses
classified within the Nidovirales order that
infect manybxvnfghsdfghfgh
animals and humans.
Two studies, published in the New England
Journal of Medicine (NEJM) and The Lancet,
investigated how long coronaviruses survive
on surfaces.
The SARS-CoV-2 virus is stable for several
hours to days in aerosols and on surfaces.
Most Coronaviruses survive for a shorter time
at higher temperatures and humidity levels
Influenza
Hours to several days
MRSA
7 days to 7 months
Clostridium Difficile
(spores)
7 days to 7 months
SARS CoV-2
• Plastic
• Stainless Steel
• Paper
• Glass
• Cardboard
• Wood
•
•
•
•
•
•
3-7 days
3-7 days
Up to 4 days
Up to 4 days
24 hours
Up to 2 days
�Basic Principles of Contact Transmission and the Role of
Low-Level Disinfectants, Cleaning and Disinfection
Spaulding Classification
Noncritical items require low-level disinfection
�Basic Principles of Contact Transmission and the Role of
Low-Level Disinfectants, Cleaning and Disinfection
Cleaning, Disinfection and Sterilization
Surfaces are cleaned before they are disinfected
�Principles of Cleaning and Disinfection
Microorganisms are transferred from environmental surfaces to patients
via direct contact with the surface or indirect contact transmission
Cleaning
Removes germs, dirt and impurities from
bxvnfghsdfghfgh
surfaces or objects
Renders the surface safe to handle
Removes organic matter and visible soil, which
interferes with disinfection
Use detergent, water and friction to physically
remove germs from surfaces
Always use a moistened cloth to avoid
contaminating the air with air-borne particles
Disinfection
Surfaces have to be cleaned before they can be
disinfected
Disinfection works by using chemicals to kill germs
left on surfaces or objects
A few spores may remain following disinfection
“Two Step” method:
• Clean a surface in one step, then apply
disinfectant in another step, allow the surface
to remain wet for required contact time
• Used for visibly soiled surfaces or high-risk
organisms
�Basic Principles of Contact Transmission and the Role of
Low-Level Disinfectants, Cleaning and Disinfection
Hierarchy of Resistance
Pathogen Resistance
to Disinfectants
�Basic Principles of Contact Transmission and the Role of
Low-Level Disinfectants, Cleaning and Disinfection
EPA Registered Antimicrobial Products
EPA-registered antimicrobial products may not make efficacy
claims against pathogens unless the Agency has reviewed data
to support the claim and approved the claim on the label
EPA has several disinfectant lists (A-N) with products that meet the
defined antimicrobial criteria of each list
• Example:
• List A: EPA’s Registered Antimicrobial Products as Sterilizers
• List B: EPA Registered Tuberculocide Products Effective
Against Mycobacterium tuberculosis
EPA-registered products are consistent with the product labeling compliance with
OSHA requirements for exposure to blood borne pathogens
�Basic Principles of Contact Transmission and the Role of
Low-Level Disinfectants, Cleaning and Disinfection
The EPA “N” List of Antimicrobial Products
SARS-CoV-2 is a new virus and not readily available for use in commercial laboratory
testing to see if disinfectant products are effective at killing the virus
While surface disinfectant products on List N have not been tested
specifically against SARS-CoV-2, the EPA expects them to kill the virus
because they:
• Demonstrate efficacy (e.g. effectiveness) against a harder-to-kill
virus
• Demonstrate efficacy against another type of human
coronavirus similar to SARS-CoV-2
All surface disinfectants on List N can be used to kill SARS-CoV-2 viruses on surfaces
Before applying any EPA-registered disinfectant product, users must read the label to
determine if the product is approved for the intended-use
�Basic Principles of Contact Transmission and the Role of
Low-Level Disinfectants, Cleaning and Disinfection
What if My Disinfectant Isn’t on the EPA “N” List?
Look for an EPA-registered product with “human coronavirus”
listed as a target pathogen on the product label
Look for the EPA registration number on the label to
confirm the product is EPA registered and follow the label
directions when using it
Products with animal coronavirus claims are not generally included on
List N because sufficient data may not be available to confirm whether
these products will work against human coronaviruses like SARS-CoV-2
�Basic Principles of Contact Transmission and the Role of
Low-Level Disinfectants, Cleaning and Disinfection
What if My Disinfectant Isn’t EPA Approved?
If a product doesn’t have an EPA registration number, then the
EPA has not reviewed any data on whether the product will kill
public health pathogens, such as viruses
EPA will not add products to List N that do not have an EPA
registration number because there is no data showing it will
work on human coronaviruses and it can be used safely
CMS requires environmental surfaces to be cleaned and disinfected using
an EPA registered disinfectant in patient care areas on a regular basis
�Content Outline (TOC)
Environmental Cleaning and Disinfection of
Surfaces in the Context of COVID-19
Kari L Love, MS, RN, CIC, FAPIC
�Environmental Cleaning and Disinfection of
Surfaces in the Context of COVID-19
Principles of Transmission
Environmental cleaning and disinfection procedures
• Appropriate contact times
• Frequently touched surfaces or objects
Medical equipment
• Dedicated, Non-dedicated, non-disposable
Terminal cleaning of rooms
• PPE to be worn by environmental services personnel
Management of laundry, food service utensils, and medical waste
Image Credit: NIAID-RML - This scanning electron microscope image shows SARS-CoV-2 (round blue objects) emerging from the surface of cells cultured in the lab
�Environmental Cleaning and Disinfection of
Surfaces in the Context of COVID-19
Product Selection
Follow the manufacturer’s instructions to ensure that disinfectants are prepared
and handled safety, wearing the appropriate personal protective equipment (PPE)
to avoid chemical exposure
ü
ü
ü
ü
ü
Selection of disinfectants
Consider microorganisms targeted,
Understand the recommended concentration and contact
time
• Contact time = Period of time a surface must remain wet
Compatibility of the disinfectant and surfaces
Toxicity and stability of the product
Ease of use
EPA Approved Disinfectants will
have the contact time for
inactivation or kill of organisms
on the product label
�Environmental Cleaning and Disinfection of
Surfaces in the Context of COVID-19
Frequently Touched Surfaces
Disinfect all “high-touch” surfaces
daily and upon discharge
• This includes horizontal,
vertical and contact surfaces
• Cleaned surfaces should
remain wet and air dry per
the label’s instruction
Clean floors on a regular basis,
when spills occur and when
visibly soiled
Inpatient Room
Clinic Exam Room
�Sample Checklist
�Equipment
Use dedicated, disposable devices when available
If a dedicated, disposable device is not available, disinfect
all non-critical patient care equipment before removing the
device from the room and before using it with another
patient
Use an EPA-registered hospital disinfectant following the
label’s instructions
Assure staff responsible for
device cleaning receive
training on cleaning
procedures that follow the
equipment manufacturer’s
instructions
�PPE for EVS Personnel
In general, only essential personnel should enter
the room of patients with COVID-19. Healthcare
facilities should consider assigning daily cleaning
and disinfection of high-touch surfaces to nursing
personnel who will already be in the room
providing care to the patient
If this responsibility is assigned to EVS
personnel, they should wear all
recommended PPE when in the room
PPE should be removed upon leaving
the room, immediately followed by
performance of hand hygiene
�Environmental Cleaning and Disinfection of
Surfaces in the Context of COVID-19
Laundry, Food Service and Waste
Management of laundry, food
service utensils, and medical
waste should also be performed
in accordance with routine
procedures
https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html
�Environmental Cleaning and Disinfection of
Surfaces in the Context of COVID-19
Conclusion
ü Follow current best practices for environmental disinfection
ü Properly train and educate environmental service technicians
on proper cleaning and disinfection processes
ü Have nursing, respiratory therapists, infection preventionists
and environmental services agree upon a list of equipment
that are to be cleaned and disinfected by nursing and by
environmental services
�Content Outline (TOC)
Environmental Cleaning Challenges and
Strategies in Post-Acute and Long-Term Care
Kate Tyner, BSN, RN, CIC
�Environmental Cleaning Challenges and
Strategies in Post-Acute and Long-Term Care
The post-acute care setting is NOT exactly like acute care
• Carpet in resident rooms
• Resident belongings and décor
• Craft and social rooms
• Independent residents
• Shared dining spaces
• Regulatory climate
• Use of medication and
treatment carts
�Environmental Cleaning Challenges and
Strategies in Post-Acute and Long-Term Care
Significant Variation in Practices Between Facilities
Ashraf, M.S., at al. Environmental Cleaning and Disinfection Policies, Protocols and Practices:
A Survey of 27 Long-Term Care Facilities https://icap.nebraskamed.com/wp-content/uploads/sites/2/2018/06/Extended-EVS-Survey-project-SHEA-2018_ICAP-Website.pptx
�Environmental Cleaning Challenges and
Strategies in Post-Acute and Long-Term Care
Regulation §483.15(a) Dignity
The facility must promote care for residents in a manner and in an environment that
maintains or enhances each resident’s dignity and respect in full recognition of his or
her individuality
• Respecting residents’ private spaces and property (e.g., not changing radio or
television station without resident’s permission, knocking on doors and requesting
permission to enter, closing doors as requested by the resident, not moving or
inspecting resident’s personal possessions without permission);
• Maintaining an environment in which there are no signs posted in residents’ rooms
or in staff work areas able to be seen by other residents and/or visitors that include
confidential clinical or personal information
American Healthcare Association, Best Practices For Compliance Related To Resident Dignity In Skilled Nursing Facilities https://www.fhca.org/members/qi/clinadmin/dignity2.pdf
�Environmental Cleaning Challenges and
Strategies in Post-Acute and Long-Term Care
Overcoming the Challenge
Standardize basic protocols and training
Environmental Services Cleaning Guidebook (Minnesota Hospital Association)
https://www.mnhospitals.org/Portals/0/Documents/ptsafety/CDICleaning/4.%20Environmental%20Services%20Cleaning%20Guidebook.pdf
Environmental Cleaning in Healthcare Training Video Series (Nebraska ICAP and ASAP)
https://icap.nebraskamed.com/practice-tools/educational-and-training-videos/
�Content Outline (TOC)
NETEC Resources
Sharon Vanairsdale, DNP, APRN, ACNS-BC, NP-C, CEN, FAEN, FAAN
�Resources
Slides 21: EPA List A: Antimicrobial Products Registered with the EPA as Sterilizers
https://www.epa.gov/pesticide-registration/list-antimicrobial-products-registered-epa-sterilizers
Slide 21: EPA List B: EPA’s Registered Tuberculocide Products Effective Against Mycobacterium Tuberculosis
https://www.epa.gov/pesticide-registration/list-b-epas-registered-tuberculocide-products-effective-against-mycobacterium
Slide 32: CDC Interim Infection Prevention and Control Recommendations for Patients with Suspected or
Confirmed Coronavirus Disease 2019
https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html
Slide 36: Environmental Cleaning and Disinfection Policies, Protocols and Practices: A survey of 27 LTC Facilities
https://icap.nebraskamed.com/wp-content/uploads/sites/2/2018/06/Extended-EVS-Survey-project-SHEA-2018_ICAP-Website.pptx
Slide 37: FHCA – Best Practices for Compliance Related to Resident Dignity in Skilled Nursing Facilities
https://www.fhca.org/members/qi/clinadmin/dignity2.pdf
Slide 38: Environmental Services Cleaning Guidebook
https://www.mnhospitals.org/Portals/0/Documents/ptsafety/CDICleaning/4.%20Environmental%20Services%20Cleaning%20Guidebook.pdf
Slide 38: Environmental Cleaning in Healthcare Training Video Series
https://icap.nebraskamed.com/practice-tools/educational-and-training-videos/
�Resources: NETEC
NETEC is Here to Help
NETEC will continue to build resources, develop online education,
and deliver technical training to meet the needs of our partners
Ask for help!
Send questions to info@netec.org - they will be answered by NETEC SMEs
Submit a Technical Assistance request at NETEC.org
�Questions
and
Answers
�Contact
NETEC eLearning Center
NETEC Skill videos
courses.netec.org
youtube.com/thenetec
Join the Conversation!
@theNETEC
@the_NETEC
Use hashtag: #NETEC
Website
Repository
Email
netec.org
repository.netecweb.org
info@netec.org
��
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
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Deploy
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Webinar
Portal access to a webinar
Duration
Length of time involved (seconds, minutes, hours, days, class periods, etc.)
Friday, June 5, 2020 | 12:00 PM CT / 1:00 PM ET
Event Type
Webinar, watch at link below
URL
https://youtu.be/6KU5_WMJHTk
Player
Field for the html for a video player.
<br /><iframe width="560" height="315" title="Environmental Cleaning and Infection Prevention webinar" src="https://www.youtube.com/embed/6KU5_WMJHTk?autoplay=0" frameborder="0"></iframe>
Alternate URL
Other URLs if necessary.
CEU online course: <a href="https://courses.netec.org/courses/20-web-envc" target="_blank" rel="noreferrer noopener">https://courses.netec.org/courses/20-web-envc</a>
Objectives
Self-paced, 1 credit.
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
NETEC COVID-19 Webinar Series (6/5/20)/Online Course: Environmental Cleaning and Infection Prevention
Subject
The topic of the resource
Infection Control
Description
An account of the resource
This webinar will describe the process for effective environmental cleaning and disinfection practices for COVID in the settings of acute care, long term care and skilled nursing facilities, identify strategies for waste and linen management, cleaning of medical equipment and proper PPE for environmental services personnel when cleaning COVID patient rooms.<br /><br />Webinar slides attached.<br />
<h2>Get educational credit for this webinar through <a href="https://courses.netec.org/courses/20-web-envc" target="_blank" rel="noreferrer noopener">Courses.netec.org</a>.</h2>
Creator
An entity primarily responsible for making the resource
NETEC
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-06-05
Contributor
An entity responsible for making contributions to the resource
2023-07-13 by Christa Arguinchona and Caroline Croyle (PM)
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2026-07-14
Type
The nature or genre of the resource
Webinar and Online Course
2019-nCoV
CEU
CEUs
Coronavirus
COVID-19
Example
Infection Prevention and Control
Long-term Care
Occupational Health
Online Course
R-IPC
R-LTC
R-PM
Terminal Clean
-
https://repository.netecweb.org/files/original/ab54adca01630a8c9b91da67439b2b17.pdf
05a633d614bf0d1b6b0dba6559037491
PDF Text
Text
NETEC COVID-19 Webinar Series:
Tackling the COVID-19 Storm
Through the Lens of Long-Term Care Facilities
�Content Outline (TOC)
Welcome
Ted Cieslak, MD, MPH
�Overview
Welcome: Ted Cieslak, MD, MPH
Washington State Public Health Response to COVID-19:
Sara Podczervinski, RN, MPH, CIC, FAPIC
Patty Montgomery, RN, MPH, CIC
House of Hope Alzheimer’s Care Response to COVID-19:
Carly Snider, Community Nurse, LPN
Tawny McWilliams,
NETEC Resources: Ted Cieslak, MD, MPH
Questions and Answers with NETEC
�Welcome
National Emerging Special Pathogens
Training and Education Center
Mission Statement
To increase the capability of the United States public health and
health care systems to safely and effectively manage individuals
with suspected and confirmed special pathogens
For more information
Please visit us at www.netec.org
or email us at info@netec.org
�NETEC Overview
Assessment
Education
Technical
Assistance
Research
Network
Empower hospitals to gauge
their readiness using
Provide self-paced
education through
Onsite & Remote
Guidance
Online Repository
Self-Assessment
Measure facility and
healthcare worker
readiness using
Metrics
Meet Fred
Online Trainings
Compile
Online Repository
Deliver didactic and handson simulation training via
In-Person Courses
of tools and resources
Develop customizable
Exercise Templates
based on the HSEEP model
Provide direct feedback
to hospitals via
On-Site
Assessment
COVID-19 focused
Webinars
Built for rapid implementation
of clinical research protocols
Provide
Emergency On-Call
Mobilization
Cross-Cutting, Supportive Activities
Develop Policies,
Procedures and
Data Capture Tools
to facilitate research
Create infrastructure for a
Specimen
Biorepository
�Content Outline (TOC)
Washington State Public Health
Response to COVID-19
Sara Podczervinski, RN, MPH, CIC, FAPIC
Patty Montgomery, RN, MPH, CIC
�Washington State Public Health Response to COVID-19
First in the Nation
https://www.nejm.org/doi/full/10.1056/NEJMoa2005412?query=featured_home
�Washington State Public Health Response to COVID-19
COVID-19 Preparedness?
“Nursing homes have been caught in the crosshairs of the coronavirus pandemic. As
of early May 2020, COVID-19 had claimed the lives of more than 28,000 nursing home
residents and staff in the United States. But U.S. nursing homes were unstable even
before COVID-19 hit. They were like tinderboxes, ready to go up in flames with just a
spark. The tragedy unfolding in nursing homes is the result of decades of neglect of
long-term care policy.”
Werner RM. NEJM. 5/27/20. https://www.nejm.org/doi/full/10.1056/NEJMp2014811
�Washington State Public Health Response to COVID-19
First in the Nation
167 cases COVID-19 linked to Facility A
• 101 facility residents (77%)
• 50 health care personnel (39%)
• 16 visitors
Preliminary case fatality rate
• 33.7% for residents
• 6.2% for visitors
• No staff members died
https://www.nejm.org/doi/full/10.1056/NEJMoa2005412?query=featured_home
�Facility Cases
Werner RM. NEJM. 5/27/20. https://www.nejm.org/doi/full/10.1056/NEJMp2014811
�Transmission Facility to Facility
Werner RM. NEJM. 5/27/20. https://www.nejm.org/doi/full/10.1056/NEJMp2014811
�Washington State Public Health Response to COVID-19
Gaps Contributing to COVID-19 Transmission at Facility A
Staff worked while symptomatic
Staff worked in more than one facility
Inadequate familiarity with, and adherence to, PPE recommendations
Challenges in implementing proper infection control practices
Inadequate supplies of PPE and hand sanitizer
Delayed recognition of cases
Limited availability of testing
Difficulty identifying persons with COVID-19 based on signs and symptoms alone
�Washington State Public Health Response to COVID-19
What Went Well
1
Good collaboration with facility and the hospital
2
The state, county and federal teams worked well together
3
The dedication and courage of the staff at the facility
4
We were able to test everyone which really helped us
gain a better understanding to cohort residents
�Washington State Public Health Response to COVID-19
It Would Have Been Great…
1
The media attention
2
More PPE (National Stockpile?)
3
Nursing home regulations had been updated sooner
4
An awareness of other at-risk settings for elders
�Washington State Public Health Response to COVID-19
Other Settings of Interest
Continuum of Settings
Neighborhood
homes where
direct-care
providers assist
2 to 6 residents
Neighborhood
facilities where
direct-care
providers assist 7
or more residents
Specialized
facilities to serve
individuals with
complex medical
and behavioral
heath needs
Facilities
providing 24/7
nursing care to
residents with
significant needs
Adult
Family
Homes
Assisted
Living
Facilities
Enhanced
Service
Facilities
Skilled
Nursing
Facilities
Clients living in
their own homes
in the community
Group Homes
Supported Living
Supported
Living
(CCRSS)
�LTC Associated Cases by Illness Onset Date 7/6/2020
Universal Masking 4/7
Visitor restrictions 3/16
Universal eye protection 7/9
https://www.doh.wa.gov/Portals/1/Documents/1600/coronavirus/data-tables/Weekly-COVID-19-Long-Term-Care-Report.pdf
�Washington State Public Health Response to COVID-19
Mitigate Risks in LTC
We have providing infection prevention assessments both onsite and remote
Long-term Care
Facility
156
Adult Family Home
155
Total
311
�Washington State Public Health Response to COVID-19
Next Steps
LATER: Reforms and regulation?
ü Higher standards for infection control programs
ü Higher staff to resident ratio
ü Higher educational standards
ü Better pay for caregivers
ü Paid sick leave and insurance
ü Different payment models for elder care
�Content Outline (TOC)
House of Hope Alzheimer’s Care
Response to COVID-19
Carly Snider, Community Nurse, LPN
Tawny McWilliams, Administrator
�Background: House of Hope Alzheimer’s Care
Location: North Omaha, Nebraska
Layout: 4 Neighborhoods with a total of 42 private apartments
• Each neighborhood houses 10 or 11
Services: Assisted Living Memory Support providing all inclusive care
Memory Care Staffing:
• One Community Nurse Manager day shift and on-call
• Two Medication Aides (1st & 2nd Shift)
• Four C.N.A’s (1st & 2nd Shift)
• One Med Aide & 3 C.N.A’s Overnight
�Preparedness: Prior to the COVID Positive Residents
Staff Support
COVID-19 Training Manual
• Hand Hygiene
• Proper PPE Donning &
Doffing
• Cleaning/Sanitizing
Engaging in 1:1 activities
with residents
�Preparedness: Prior and During pandemic
Processes to support COVID-19 Positive Residents:
•
•
•
•
Screening staff and residents
PPE
Visitor restrictions
Volunteer restrictions
•
•
•
•
Non-essential staffing (E.g. hairdresser)
Staff break rooms
Staffing and job duties
Stocking up supplies
�The Experience: Discovering COVID-19 Positive Residents
Discovery: Staff Member
How many? 10 Resident and 2 Staff
How many residents may have been exposed? 42
What about staff? 4 directly and up to 10 potential
�COVID-19 Activation
All planning processes were kept in place from the preparation stage
• Moved screening process from paper to digital
Worked closely with ICAP to verify processes, this collaboration led to changes
• Entrance and exit locations
• Doffing and donning areas
�COVID-19 Activation
Isolating patients went better than expected
• Challenges with residents understanding the limitations
placed on movement outside of their individual apartments
Creating COVID negative and COVID positive zones
• Isolated patients by room
• Did not move residents to different areas
• Dedicated C.N.A.s, Medication Aide and Nurse
manager for each area
• Used a color sign system to differentiate positive and
negative rooms
• Offered staff a safe area to change clothes and shower
prior to exiting their shift
• Memory Care staff did not use the main timeclock
• Implemented a paper time sheet
�COVID-19 Activation
Possible resident exposure:
• Monitored for signs/symptoms
• Initial symptoms: diarrhea and runny nose
Testing:
• Tested 8 residents on April 7th due to being
symptomatic
• Received positive results on April 8th, which
prompted further testing in the two adjoining
neighborhoods on April 9th
• Positives remained in the two adjoining
neighborhoods
• All residents and staff were tested May 2nd
• Results received May 7th with all negative,
• Exception - one resident remained positive, tested
negative May 19th
�COVID-19 Activation
Mealtime
• C.N.As delivered meals
• Served on paper products
• Residents that could feed themselves and
did not need cues or reminders were
served first
• Residents that needed assistance were
served last after in order to provide
appropriate attention
�What Worked Well
1
ü
ü
ü
ü
ü
Leadership/Teamwork/Support
Being present and a leader on the floor
Communication: being open, honest, and listening
Strong support system
Open to ideas
Continuous teaching and learning, being an example
�What Worked Well
2
Building Layout
Memory Care layout was beneficial
All private apartments and bathrooms
Separate entrances and exits for positive/negative areas
Dedicated staff in negative areas – did not cross staff
between other parts of community
ü Staff was all-inclusive
ü
ü
ü
ü
�What Worked Well
3
ü
ü
ü
ü
ü
Infection Control Practices
Direct care staff cleaned/sanitized multiple times a shift
Dedicated staff: no maintenance, housekeeping, activity, or management
Removed and turned around furniture
Snacks and treats were individualized
Washable gowns
�Three Things That Would Have Been Good to Have in Place
1
Staff preparation
2
Training
3
Supplies and dedicated equipment
�Content Outline (TOC)
NETEC Resources
Ted Cieslak, MD, MPH
�Resources: NETEC
NETEC is Here to Help
NETEC will continue to build resources, develop online education,
and deliver technical training to meet the needs of our partners
Ask for help!
Send questions to info@netec.org - they will be answered by NETEC SMEs
Submit a Technical Assistance request at NETEC.org
�Questions
and
Answers
�Contact
NETEC eLearning Center
NETEC Skill videos
courses.netec.org
youtube.com/thenetec
Join the Conversation!
@theNETEC
@the_NETEC
Use hashtag: #NETEC
Website
Repository
Email
netec.org
repository.netecweb.org
info@netec.org
��
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Deploy
Description
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<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Webinar
Portal access to a webinar
Duration
Length of time involved (seconds, minutes, hours, days, class periods, etc.)
Wednesday, July 15, 2020 | 1:00 PM EST
Event Type
Webinar, view at link below
URL
https://youtu.be/G62D2h9vW-w
Player
Field for the html for a video player.
<br /><iframe width="560" height="315" title="Long-Term Care part 1 webinar" src="https://www.youtube.com/embed/G62D2h9vW-w?autoplay=0" frameborder="0"></iframe>
Alternate URL
Other URLs if necessary.
CEU online course: <a href="http://courses.netec.org/courses/20-web-ltc1" target="_blank" rel="noreferrer noopener">http://courses.netec.org/courses/20-web-ltc1</a>
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NETEC COVID-19 Webinar Series (7/15/20)/Online Course: Tackling the COVID-19 Storm through the Lens of Long-Term Care Facilities: Part 1
Subject
The topic of the resource
Emergency Management
Description
An account of the resource
In this webinar, participants will discuss different policies and processes taken at long-term care facilities caring for COVID-19 positive residents based on case-based experiences, describe mitigation strategies involved to promptly identify and isolate residents with possible COVID-19 utilizing appropriate infection prevention practices, and describe the role of local and state public health in the identification, prevention, and control of COVID-19 in long-term facilities.<br /><br />Webinar slides attached.<br />
<h3>Go to <a href="https://repository.netecweb.org/items/show/1207">Part 2 of this webinar</a>.</h3>
<h2>Get educational credit for this webinar through <a href="http://courses.netec.org/courses/20-web-ltc1" target="_blank" rel="noreferrer noopener">Courses.netec.org</a>.</h2>
Creator
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NETEC
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-07-15
Type
The nature or genre of the resource
Webinar and Online Course
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-01-01
2019-nCoV
CEU
CEUs
Coronavirus
COVID-19
Epidemic
Long-term Care
Online Course
Pandemic
R-LTC
-
https://repository.netecweb.org/files/original/fb5128e83021383c6ee969b886452bfb.pdf
15e33005abd8ec32e7a0af2c0b1a1c45
PDF Text
Text
NETEC COVID-19 Webinar Series:
Identifying Hazards and Mitigating Risks
for Long Term Care Facilities
�Content Outline (TOC)
Welcome
Shelly Schwedhelm, MSN, RN, NEA-BC
�Overview
Welcome:
Shelly Schwedhelm, MSN, RN, NEA-BC
Considerations for Long Term Care Facilities:
Kate Boulter, RN, BAN, MPH
Infection Control for Long Term Care Facilities:
Trish Tennill, RN, BSN
Personal Protective Equipment for Long Term Care Facilities:
Jill Morgan, RN, BSN
NETEC Resources: Shelly Schwedhelm, MSN, RN, NEA-BC
Questions and Answers with NETEC
�Welcome
National Emerging Special Pathogens
Training and Education Center
Mission Statement
To increase the capability of the United States public health and
health care systems to safely and effectively manage individuals
with suspected and confirmed special pathogens
For more information
Please visit us at www.netec.org
or email us at info@netec.org
�NETEC Overview
Assessment
Education
Technical
Assistance
Research
Network
Empower hospitals to gauge
their readiness using
Provide self-paced
education through
Onsite & Remote
Guidance
Online Repository
Self-Assessment
Measure facility and
healthcare worker
readiness using
Metrics
Meet Fred
Online Trainings
Compile
Online Repository
Deliver didactic and handson simulation training via
In-Person Courses
of tools and resources
Develop customizable
Exercise Templates
based on the HSEEP model
Provide direct feedback
to hospitals via
On-Site
Assessment
COVID-19 focused
Webinars
Built for rapid implementation
of clinical research protocols
Provide
Emergency On-Call
Mobilization
Cross-Cutting, Supportive Activities
Develop Policies,
Procedures and
Data Capture Tools
to facilitate research
Create infrastructure for a
Specimen
Biorepository
�Content Outline (TOC)
Considerations for Long Term Care Facilities
Kate Boulter, RN, BAN, MPH
�Considerations for Long Term Care Facilities
COVID-19 Cases and Deaths in Long Term Care
Data reported as of the week ending: 07/05/2020 https://data.cms.gov/stories/s/COVID-19-Nursing-Home-Data/bkwz-xpvg/
�Considerations for Long Term Care Facilities
Why Long Term Care Facilities
Communal living
High representation of:
• High risk population >65 yrs old
• Chronic medical conditions
Staffing Model
• Agency and staff who work in multiple facilities
Transfers from other care areas
�Surveillance
Identify
• Symptom surveillance of residents
and everyone entering the facility
Isolate
• Separate from rest of the facility
Inform
• Public health and other stakeholders
CDC Guidance on preparing nursing homes
https://www.cdc.gov/coronavirus/2019-ncov/hcp/long-term-care.html
�Isolation and Quarantine Strategy
Red Zone
Cohort residents
Cohort staff
Residents who
attend outpatient
appointments
(Isolation Zone)
Yellow Zone
(Quarantine Zone)
Green Zone
(COVID-19 FREE Zone)
Gray Zone
(Transitional Zone)
COVID-19 Positive residents and
symptomatic residents suspected of
having COVID-19
Symptomatic residents suspected of
having COVID-19
Asymptomatic residents without any
exposure to COVID-19
Residents who are being transferred
from the hospital/outside facilities
(but have no known exposure to COVID-19)
�Challenges for Long Term Care Facilities
Facility design:
• Airflow
• Doors
• Poly walls
Floor coverings
Home style decor and personal
furnishings and decorations
�Considerations for Long Term Care Facility
Challenges in Long Term Care Facilities
Resident cohorts
Shared vs private accommodations
Visitors and volunteers
Staffing model
Resident activities
Non-essential services
�Considerations for Long Term Care Facility
Being Prepared – Two Conditions
Facilities without COVID-19 positive cases
Implementing measures to prevent
COVID-19 from entering the facility
Facilities with COVID-19 positive cases
Care for the residents who are infected
Implementing measures to protect the
residents who are not infected
�Content Outline (TOC)
Infection Control
for Long Term Care Facilities
Trish Tennill, RN BSN
�Infection Control for Long Term Care Facilities
Symptom Screening
Screen everyone:
• Staff
• Visitors (if allowed)
• Vendors
EMS
�Infection Control for Long Term Care Facilities
Education
qStaff
qResidents
•
•
•
•
•
qVisitors
Hand hygiene
Visitation policy
Masking policy
PPE
What to do if they become ill
�Infection Control for Long Term Care Facilities
Maintaining Infection Prevention Standards
A dedicated infection
preventionist
Maintain adequate supplies
Bedside staff
Environmental cleaning
Dietary
�Infection Control for Long Term Care Facilities
Laundry, Food Service and Waste
Management of laundry, food service
utensils, and medical waste can be
performed in accordance with standard
procedures
�Infection Control for Long Term Care Facilities
Where Do We Go From Here?
Back to the basics
https://www.cdc.gov/coronavirus/2019-ncov/community/clean-disinfect/index.html
�Infection Control for Long Term Care Facilities
Cleaning and Disinfection
Surfaces must be cleaned before they are disinfected
Cleaning
Disinfection
The removal of visible soil to
prepare for disinfection
The process of destroying
pathogenic microorganisms
Some organic or inorganic
material can interfere with the
effectiveness of the disinfectant
Disinfectants destroy the cell
wall of microbes or interfere
with their metabolism.
Use EPA approved disinfectants that are labeled for use against the pathogen
�Infection Control for Long Term Care Facilities
How to Clean and Disinfect
Cleaning
Use a clean, reusable cloth or disposable wipe
Apply friction to remove gross contamination
Rinse or wipe with cloth dampened with water
to remove cleaning product residue
Disinfection
Read and follow the instructions provided by the
disinfectant manufacturer
Observe the contact time by ensuring the
surface being cleaned stays wet for the time
indicated and allowed to air dry
Clean and Disinfect all “high-touch” surfaces daily and as needed - often
Include ALL high-touch surfaces
Create daily and high touch cleaning checklist
�Infection Control for Long Term Care Facilities
Name:
Date:
/
/
High-touch Room Surfaces
Create a checklist
ü
when complete
Disinfectant Agent to be
Used
Bed rails / controls
Tray table (both surfaces) (positioning buttons)
IV pole/pump control panel
IV pumps
Call light and cord
Telephone
Determine who is
responsible for cleaning
and disinfection HCW/ EVS
Television control panel and/or television remote
O2/Air/Suction controls on headwall
Bedside storage drawer handles
Chair (seat and arm rests)
Horizontal surfaces (window sill/cupboards)
Room light switch
Room door knob (inner only)
Door frame area above/below door handle (inside of door only)
High touch areas on equipment i.e. ventilator control panel
Educate on technique
and contact times
Check sharps container (replace per protocol if 2/3 full)
Computer workstation (exposed surfaces)
Alcohol gel dispenser
Thermometer
Others
Evaluate the following additional sites for visible soil
Floor contamination/Wall contamination/Horizontal surface contamination
Empty/re-bag trash/ Check sharps container
Disinfectant
Contact time
�Infection Control for Long Term Care Facilities
Infection Control
Staff who screen positive
Return to work policies
https://www.cdc.gov/coronavirus/2019-ncov/hcp/return-to-work.html
�Content Outline (TOC)
Personal Protective Equipment
For Long Term Care Facilities
Jill Morgan, RN, BSN
�Risk and Respiratory Protection
ü N95's all shifts, all staff, fit-tested,
seal check done
ü Private Rooms
ü Negative Pressure AIIR
ü Disposable single-use gowns
ü Clients in masks
ü ABHR throughout
ü Staff space >6' separation
ü Staff able to self-quarantine
ü Staff have no familial/home risks
ü Supplies and equipment cleaned
or isolated
N95 with fit-testing and user seal
check (or reusable equivalent FFR)
KN95, R95, P95
FDA approved Surgical
Or procedure mask
Cloth mask
�Respiratory Protection
WHAT you wear may be less important than HOW you wear it
?
Can you wear w/o touching, manipulating, repositioning?
?
?
Can you wear for the entire time you are near others or in a confined space?
?
?
Can you perform hand hygiene immediately
if you do have to touch your mask or respirator?
?
?
N95's - Can you get a good seal?
Do you always perform a user seal check?
?
Evidence shows that a poorly fitting N95 provides about the
same protection as a conventional surgical or procedure mask
�Source Control and PPE
Cloth masks serve as Source Control protecting others
q Reduce small exhaled particles
q Reduce larger wet droplets that could contaminate surfaces, others
q Keeps our hands off our noses and mouths
Surgical masks or N95-type respirators serve as PPE for Personal Protection
q Reduce small exhaled and inhaled particles
q Reduce and repel larger wet droplets
q Keep our hands off our noses and mouths
�PPE Fundamentals
COVER your nose and mouth when you are performing patient care, do not touch the
PPE once on, perform hand hygiene if you must touch or adjust PPE
Protect your eyes with goggles, safety glasses or a face shield
• Corrective lenses do not count
Use gloves as normal but pay close attention to what you are touching, perform
hand hygiene or gloved-hand hygiene. Be thorough and rub until dry
Have a safe, clean space like a paper gift bag to store your PPE in between uses
Re-use PPE only when safe to do so – still protective, not grossly contaminated
Do not attempt to clean or sanitize your PPE yourself
• Do not microwave, wipe or soak
�Personal Protective Equipment
Residents with known or suspected COVID-19 should be cared for using all recommended PPE, which includes use
of an N95 or higher-level respirator (or facemask if a respirator is not available), eye protection (i.e., goggles or a face
shield that covers the front and sides of the face), gloves, and gown. Cloth face coverings are not considered PPE
and should not be worn when PPE is indicated.
Because of the higher risk of unrecognized infection among residents, universal use of all recommended PPE for the
care of all residents on the affected unit (or facility-wide depending on the situation) is recommended when even a
single case among residents or HCP is newly identified in the facility; this could also be considered when there is
sustained transmission in the community.
https://www.cdc.gov/coronavirus/2019-ncov/hcp/long-term-care.html
�Personal Protective Equipment
q Trash can outside room to receive discarded PPE
q Convenient placement of ABHR, portable stand, or on staff work cart
q A location and procedure for cleaning PPE and storing for re-use –
goggles, face shields, masks, respirators, gowns
q Bundle care tasks
q Replace PPE mask or respirator with cloth mask when outside of resident
care environment
q Prioritize gowns to patients with concurrent infections – like C. Diff, wet
procedures, or when staff will be on close physical contact with residents
�PPE Re-use
How can you make the re-use of PPE safe and effective?
Stations, tables or carts outside rooms, in the hallways
Cleaning and storage supplies
Small trash can
Alcohol-based hand rub
(ABHR)
�PPE for Long Term Care Facilities
Personal Protective Equipment Resources
Know Your PPE:
https://repository.netecweb.org/files/original/8a4e0ca69136f087ca297dafa15d1760.pdf
PPE Safety:
https://repository.netecweb.org/files/original/f227e6c708549b770225b9883e686403.pdf
ASHRAE.ORG COVID-19 Resources:
https://www.ashrae.org/technical-resources/healthcare#disinfection [ashrae.org]
�Content Outline (TOC)
NETEC Resources
Shelly Schwedhelm, MSN, RN, NEA-BC
�Resources: NETEC
NETEC is Here to Help
NETEC will continue to build resources, develop online education,
and deliver technical training to meet the needs of our partners
Ask for help!
Send questions to info@netec.org - they will be answered by NETEC SMEs
Submit a Technical Assistance request at NETEC.org
�Questions
and
Answers
�Contact
NETEC eLearning Center
NETEC Skill videos
courses.netec.org
youtube.com/thenetec
Join the Conversation!
@theNETEC
@the_NETEC
Use hashtag: #NETEC
Website
Repository
Email
netec.org
repository.netecweb.org
info@netec.org
��
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
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Deploy
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Webinar
Portal access to a webinar
Duration
Length of time involved (seconds, minutes, hours, days, class periods, etc.)
Wednesday, July 22, 2020 | 1:00 PM EST
Event Type
Webinar, watch at link below
URL
https://youtu.be/1HBVVeVOAuk
Player
Field for the html for a video player.
<br /><iframe width="560" height="315" title="Long-Term Care part 2 webinar" src="https://www.youtube.com/embed/1HBVVeVOAuk?autoplay=0" frameborder="0"></iframe>
Alternate URL
Other URLs if necessary.
CEU online course: <a href="http://courses.netec.org/courses/20-web-ltc2" target="_blank" rel="noreferrer noopener">http://courses.netec.org/courses/20-web-ltc2</a>
Dublin Core
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Title
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NETEC COVID-19 Webinar Series (7/22/20)/Online Course: Tackling the COVID-19 Storm through the Lens of Long-Term Care Facilities: Part 2
Subject
The topic of the resource
Treatment & Care
Description
An account of the resource
In this webinar, participants will discuss different policies and processes taken at long-term care facilities caring for COVID-19 positive residents based on case-based experiences, describe mitigation strategies involved to promptly identify and isolate residents with possible COVID-19 utilizing appropriate infection prevention practices, and describe the role of local and state public health in the identification, prevention, and control of COVID-19 in long-term facilities.<br /><br />Webinar slides attached.<br />
<h3>Go to <a href="https://repository.netecweb.org/items/show/1206">Part 1 of this webinar</a>.</h3>
<h2>Get educational credit for this webinar through <a href="http://courses.netec.org/courses/20-web-ltc2" target="_blank" rel="noreferrer noopener">Courses.netec.org</a>.</h2>
Creator
An entity primarily responsible for making the resource
NETEC
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-07-22
Type
The nature or genre of the resource
Webinar and Online Course
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-01-01
2019-nCoV
CEU
CEUs
Coronavirus
COVID-19
Epidemic
Long-term Care
Online Course
Pandemic
R-LTC
-
https://repository.netecweb.org/files/original/950e75da1468a5a87a22ec88919a25f3.pdf
bc94d18303884b31fb5de56d8b7b370d
PDF Text
Text
The Chain of Infection
and
How to Use it to Prevent the Spread of Infection in LTC
The chain of infection is the process
a pathogen follows to cause
disease.
Germs
Susceptible
Host
A Reservoir
or Host
Portal of
Entry
Portal of
Exit
This diagram displays the process
and shows how there are 6
opportunities to break the chain
to halt or control the spread
of infection.
Understanding how the chain of
infection can be broken will help
protect you, other staff, your
residents and your contacts.
Mode of
Transmission
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�The Chain of Infection
and
How to Use it to Prevent the Spread of Infection in LTC
The chain of infection begins
with the presence of germs
ü
Germs are microscopic organisms that can be found almost everywhere:
Water
Animals
Plants
Soil
Air
ü
Bacteria, viruses, fungi, and protozoa are all types of germs.
ü
Some germs do us no harm, but others can make us sick and even cause death.
ü
Some germs cause infection for which we have no vaccine or treatments.
This makes it especially important to break the chain of infection.
Examples of infections caused by each type of germ
VIRUSES
FUNGI
PROTOZOA
COVID-19
Candida Auris
Malaria
Botulism
Smallpox
Histoplasmosis
Giardia
Plague
Ebola
Ringworm
Toxoplasmosis
Methicillin-resistant
staphylococcus aureus
(MRSA)
Rabies
Cryptococcus
Hookworm
Norovirus
Aspergillus
Amoebic dysentery
BACTERIA
C-diff
Anthrax
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(PARASITES)
�The Chain of Infection
and
How to Use it to Prevent the Spread of Infection in LTC
How germs become present in your facility
ü
There are many ways germs can enter your facility - some common ways are:
In staff, visitors and vendors who are sick.
ü
On staff, visitors, and vendors who have touched something that was contaminated with
the germs before entering the facility, such as a doorknob, gas pump, or grocery cart.
ü
Residents can also introduce germs into facilities For example, a resident who is
put on antibiotics and then develops C-diff that can lead to an outbreak.
How to prevent germs from entering the facility
• If you are sick, stay home from work and seek medical treatment if needed.
• Ensure that everyone performs proper hand hygiene before entering the facility.
• Screen staff, visitors, and vendors for signs and symptoms of infection. If they have any signs or symptoms,
they should not be allowed access.
• Know what items coming into the facility may carry germs to exclude or disinfect them.
• If there is an outbreak that is contagious before symptoms appear, use source control measures.
For example, wearing masks, handwashing, and implementing physical distance strategies.
• Conduct disease surveillance for early recognition of an infection in residents to prevent an outbreak of
e.g., C-diff or norovirus.
• Stay informed on current risks and what needs to be done to prevent an infectious outbreak in the facility.
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�The Chain of Infection
and
How to Use it to Prevent the Spread of Infection in LTC
The next link
Reservoir
Host
Example
Reservoir or Host
A reservoir is the habitat where germs can live, thrive, and multiply without
causing harm or illness and in some cases are helpful.
A host gets infected by germs and can become sick.
Ebola virus can live in bats without causing them any harm, but a human
infected with the Ebola virus will become very sick and may die.
What are potential reservoirs or hosts in a LTC facility?
Reservoir
Host
• The nests of wild animals or birds on the premises where e.g., influenza A virus can be present.
• Pools of water. For example, pseudomonas can be found in ice machines, leaky pipes, and sinks.
• Unsanitary conditions. For example, a dirty bedside commode could harbor C-diff.
Resident
Staff member
Vendor or visitor
What can be done in LTC Facilities to prevent reservoirs and hosts?
• Stop wild animals or birds from nesting on the premises where people may come in contact with
e.g., nests and fecal matter.
• Avoid creating reservoirs by keeping all areas clean and free from clutter that can hide a reservoir.
For example, keep utility rooms clean and cleaning equipment well maintained and stored properly.
• Avoid being a host by protecting yourself from a reservoir by wearing gloves before touching
something that may be harboring germs or performing hand hygiene after touching it.
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�The Chain of Infection
and
How to Use it to Prevent the Spread of Infection in LTC
The next link
Portal of Exit
The portal of exit is the route germs use to leave a host
This can be from a natural opening in our body such as our:
• GI system
• Nose
• Mouth
• Urinary system
• Sweat glands
• Tear ducts
Germs can also exit through breaks in our body’s integrity:
• Open sores
• Open wounds
• On devices that enter and leave our bodies
i.e., needles and drains
What can be done to prevent germs from leaving a host?
Unfortunately, we can’t always stop germs from exiting a host,
but we can prevent them from reaching a new host:
• Use source control. For example, by having a person infected with a respiratory illness
wear a face mask when around others.
• Keep wounds and sores covered to prevent secretions or blood leaking from them.
• Use safety devices to cover needles and dispose of them appropriately.
• Be aware of what portal of exit a pathogen will use to know how to avoid it. For example,
Tuberculosis uses the respiratory tract so wear an N95 respirator around anyone infected with TB.
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�The Chain of Infection
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How to Use it to Prevent the Spread of Infection in LTC
Mode of Transmission
The next link
This is how germs get from one place to another
Direct transmission
• This happens when there is human-to-human contact.
• Germs spread using human-to-human transmission when we have unprotected contact with
an infected person during care and non-care activities such as when we:
Assist with ambulation
Assist with bathing
Kiss
Assist with dressing
Assist with feeding
Hug
Assist with toileting
Obtain vital signs
Shake or hold hands
Indirect transmission
This happens when infections are passed on without human-to-human contact
For example, when:
• Germs are coughed into the air and then breathed in by another person.
• Secretions from a wound leak onto a surface that is then touched by another person.
• Germs are dispersed into the air and breathed in during a change of linens from an
infected person’s bed.
• Germs are dispersed into the air and breathed in when waste is pushed down to make
room in a trash container.
• The breeze from a fan blowing in an infected person’s room carries germs to an area
where someone breathes them in.
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�The Chain of Infection
and
How to Use it to Prevent the Spread of Infection in LTC
What can we do to avoid germs being transmitted to others?
Avoid unprotected contact with a sick resident or potentially infected surface:
• Wear PPE such as gloves, eye protection, gowns, and masks.
Avoid doing anything in a way that can disperse pathogens into the air:
• Flapping or shaking linens into the air.
• Using fans or having air blowing where it can carry germs.
• Compacting waste in trash cans.
Perform proper hand hygiene:
• Before and after providing any care task. For example, toileting, dressing, bathing, and feeding.
• After touching any surface or using equipment, even if you only did a small task such as
straightening a bedside table.
• Before eating and drinking or touching your own face.
Avoid contact with splashes when emptying urinary catheters, ostomies, and other drains.
Keep wounds covered.
Keep surfaces disinfected, especially in rooms where there are sick residents.
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�The Chain of Infection
and
How to Use it to Prevent the Spread of Infection in LTC
The next link
Portal of Entry
This is how germs get into our bodies to cause infection
There are several ways germs get into our bodies to cause infections, such as:
• Inhaling them into our respiratory system.
• Having contact with our mucous membranes
such as our eyes and mouth.
• Through tubes such as urinary catheters,
wound drains, or an IV.
• Eating or drinking contaminated foods and
drinks.
• Allowing an infected substance to come in
contact with openings in our skin, such as cuts,
sores, or wounds.
How to prevent pathogens getting into our bodies
• Wear a mask that covers our nose and mouth to prevent breathing them in.
• Avoid taking germs to our nose, mouth, or eyes with unclean hands.
• Keep wounds covered to prevent germs from coming in contact with them.
• Perform meticulous care on lines and tubes – work clean to dirty.
• Always perform proper hand hygiene before and after contact with others or surfaces.
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�The Chain of Infection
and
How to Use it to Prevent the Spread of Infection in LTC
The last link
Susceptible Host
This is someone who does not have immunity or ability to fight off the germs
A susceptible host could be you, your residents, other staff, and any of your contacts.
Keep in mind that:
• Residents are more susceptible to germs because as we age our immune systems weaken.
• Residents who have a chronic illness are more susceptible to germs i.e., residents
with kidney failure who are going through dialysis.
• Residents who are immunosuppressed are more susceptible to germs i.e., residents
undergoing chemotherapy for cancer treatment.
• Residents who have invasive medical devices i.e., a urinary catheter are also at more risk.
Everyone is a susceptible host anytime there is a new pathogen
or a disease that is not seen often and to which there is no vaccine
How to protect susceptible hosts
• Take steps to avoid getting infected:
• Wear and use PPE properly.
• Perform proper hand hygiene often and before and after touching residents.
• If available, get vaccinated to protect yourself, residents and others.
• Take steps to not carry germs from one room to another:
• Perform proper hand hygiene.
• Change PPE.
• Don’t rely on having immunity from a previous illness with the germ.
• It’s not always predictable on how long immunity lasts
• Some germs are able to mutate making it possible to be reinfected.
• Follow your facility infection prevention strategies.4.29.2022
�The Chain of Infection
and
How to Use it to Prevent the Spread of Infection in LTC
Summary
The chain of infection has six links
that can be broken to stop or control
the spread of infection.
Germs
Fortunately, germs don’t move
around in facilities on their own they rely on contact with someone,
or something to move them around.
A Reservoir
or Host
Susceptible
Host
Take steps to break the links in the
chain of infection to keep yourself
safe, and by doing that, you will
keep your residents safe.
Portal of
Exit
Portal of
Entry
Mode of
Transmission
LET'S WORK TOGETHER
TO FIGHT OFF GERMS
4.29.2022
�
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Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Guide
Document providing operation or response information, general guidance documents.
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
The Chain of Infection and How to Use it to Prevent the Spread of Infection in LTC
Subject
The topic of the resource
Infection Control
Description
An account of the resource
This printable flyer infographic describes the Chain of Infection and How to Use it to Prevent the Spread of Infection in Long-Term Care (LTC).
Creator
An entity primarily responsible for making the resource
NETEC
Date
A point or period of time associated with an event in the lifecycle of the resource
2022-05-02
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-05-02
Chain of infection
Infection Prevention and Control
Long-term Care
R-LTC