QSO-20-39-NH REVISED 09.23.2022
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Clearpol's Opinion of this Guidance as of 09/23/2022
This revision provides
· Updated guidance for face coverings and masks during visits
· Removed vaccination status from the guidance
CDPH has not yet issued a revised AFL.
Regardless of how visits are conducted, there are certain core principles and best practices that reduce the risk of COVID-19 transmission, consistent with CDC guidance for SNFs that should be adhered to at all times:
Core Principles of COVID-19 Infection Prevention
· Facilities should provide guidance (e.g., posted signs at entrances) about recommended actions for visitors who have a positive viral test for COVID-19, symptoms of COVID-19, or have had close contact with someone with COVID-19. Visitors with confirmed COVID-19 infection or compatible symptoms should defer non-urgent in-person visitation until they meet CDC criteria for healthcare settings to end isolation. For visitors who have had close contact with someone with COVID-19 infection, it is safest to defer non-urgent in-person visitation until 10 days after their close contact if they meet criteria described in CDC healthcare guidance (e.g., cannot wear source control).
· Facilities should screen all who enter for these visitation exclusions
· Screening of all who enter the facility for signs and symptoms of COVID-19
· Hand hygiene (use of alcohol-based hand rub is preferred)
• Face covering or mask (covering mouth and nose) in accordance with CDC guidance
• Instructional signage throughout the facility and proper visitor education on COVID-19 signs and symptoms, infection control precautions, other applicable facility practices
• Cleaning and disinfecting high frequency touched surfaces in the facility often, and designated visitation areas after each visit
• Appropriate staff use of PPE
• Effective cohorting of residents
• Resident and staff testing conducted as required
Outdoor Visitation
While taking a person-centered approach and adhering to the core principles of COVID-19 infection prevention, outdoor visitation is preferred. Outdoor visits pose a lower risk of transmission due to increased space and airflow. Weather considerations or an individual resident’s health status (e.g. medical condition(s), COVID-19 status, quarantine status) may hinder outdoor visits.
Facilities should create accessible and safe outdoor spaces for visitation, such as in courtyards, patios, or parking lots, including the use of tents, if available. When conducting
outdoor visitation, all appropriate infection control and prevention practices should be followed.
Indoor Visitation
Facilities must allow indoor visitation at all times and for all residents as permitted under the regulations. While previously acceptable during the PHE, facilities can no longer limit the frequency and length of visits for residents, the number of visitors, or require advance scheduling of visits. Although there is no limit on the number of visitors that a resident can have at one time, visits should be conducted in a manner that adheres to the core principles of COVID-19 infection prevention and does not increase risk to other residents. During peak times of visitation and large gathering, facilities should encourage physical distancing.
Face Coverings and masks during visits
If the nursing home’s county COVID-19 community level of transmission is high, everyone in a healthcare setting should wear face coverings or masks.
If the nursing home’s county COVID-19 transmission is not high, the safest practice is for residents and visitors to wear face coverings or masks \however the facility could choose not to require visitors wear face coverings or masks while in the facility, except during an outbreak. The facility’s policies regarding face coverings and masks should be based on recommendations from the CDC, state and local health departments, and individual facility circumstances.
Regardless of the community transmission level, residents and their visitors when alone in the resident’s room or in a designated visitation area, may choose not to wear face coverings or masks and may choose to have close contact (including touch). Residents (or their representative) and their visitors should be advised of the risks of physical contact prior to the visit. If a roommate is present during the visit, it is safest for the visitor to wear a face covering or mask.
CDC states that Community Transmission is the metric currently recommended to guide select practices in healthcare settings to allow for earlier intervention, before there is strain on the healthcare system, including its workforce, and better protect the vulnerable individuals seeking care in these settings. The Community Transmission metric is different than the COVID-19 Community Level metric used for non-healthcare settings. Nursing homes should use the Community Transmission Level metric not the Community Level metric.
Indoor Visitation during an Outbreak Investigation
An outbreak investigation is initiated exists when a single new case of COVID-19 occurs among residents or staff to determine if others have been exposed. To swiftly detect cases, facilities are reminded to adhere to CMS regulations and guidance for COVID-19 testing, including routine staff testing, testing of individuals with symptoms, and outbreak testing.
When a new case of COVID-19 among residents or staff is identified, a facility should immediately (but not earlier than 24 hours after the exposure, if known) begin outbreak testing in accordance with CMS QSO 20-38-NH REVISED and CDC guidelines.
While it is safer for visitors not to enter the facility during an outbreak investigation, visitors must still be allowed in the facility. Visitors should be made aware of the potential risk of visiting during an outbreak investigation and adhere to the core principles of infection prevention. If residents or their representative would like to have a visit during an outbreak investigation, they should wear face coverings or masks during visits, and visits should ideally occur in the resident’s room. While an outbreak investigation is occurring, facilities should limit visitor movement in the facility. Also, visitors should physically distance themselves from other residents and staff, when possible. Facilities may contact their local health authorities for guidance or direction on how to structure their visitation to reduce the risk of COVID-19 transmission during an outbreak investigation.
Visitor Testing and Vaccination
While not required, facilities in high levels of community transmission are encouraged to offer testing to visitors, if feasible. While visitor testing and vaccination can help prevent the spread of COVID-19 and facilities may ask about a visitors’ vaccination status, visitors are not required to be tested or vaccinated (or show proof of such) as a condition of visitation. If the visitor declines to disclose their vaccination status, the visitor should wear a face covering or mask at all times.
Required Visitation
Facilities shall not restrict visitation without a reasonable clinical or safety cause. Therefore, facilities must facilitate in-person visitation consistent with the regulations, which can be done by applying the guidance stated above.
Access to the Long-Term Care Ombudsman
Representatives must be provided with immediate access to any resident.
Federal Disability Rights Laws and Protection & Advocacy (P&A) Programs
Representatives of a P&A program must be provided with immediate access to a resident.
Entry of Healthcare Workers and Other Providers of Services
All healthcare workers must be permitted to come into the facility as long as they are not subject to a work exclusion or showing signs or symptoms of COVID-19 exposure or screening symptoms. In addition to health care workers, personnel educating and assisting in resident transitions to the community should be permitted entry consistent with this guidance. EMS personnel do not need to be screened, so they can attend to an emergency without delay. All staff and others providing services should adhere to the core principles of COVID-19 infection prevention and must comply with COVID-19 testing requirements.
Communal Activities and Dining and Resident Outings
These may occur while adhering to the core principles of COVID-19 infection prevention. Residents may eat in the same room with social distancing. The safest approach is for everyone, particularly those at high risk for severe illness, to wear a face covering or mask while in communal areas of the facility.
Facilities must permit residents to leave the facility as they choose. Should a resident choose to leave, the facility should remind the resident and any individual accompanying the
resident to follow all recommended infection prevention practices such as wearing a face covering or mask, especially for those at high risk for severe illness and when community transmission is high, performing hand hygiene and to encourage those around them to do the same.
Upon the resident’s return, nursing homes should screen residents for signs or symptoms of COVID-19:
o If the resident or family member reports possible close contact to an individual with COVID-19 while outside of the nursing home, see the CDC’s guidance for residents who have had close contact for next steps regarding testing and quarantine
o If the resident develops signs or symptoms of COVID-19 after the outing, see the CDC’s guidance for residents with symptoms of COVID-19.
In most circumstances, quarantine is not recommended for residents who leave the facility for less than 24 hours (e.g., for medical appointments, community outings with family or friends) except in certain situations, described in the CDC’s empiric transmission-based precautions guidance.
Residents who leave the facility for 24 hours or longer should generally be managed as a new admission, as recommended by the CDC in the Managing admissions and residents who leave the facility section.
• Monitor residents for signs and symptoms of COVID-19 daily
Residents who leave the facility for 24 hours or longer should generally be managed as a new admission or readmission, as recommended by the CDC’s “Interim Infection Prevention and Control Recommendations to Prevent SARS-CoV-2 Spread in Nursing Homes.” Please note that there are exceptions to quarantine, including for residents who are up-to-date with all recommended COVID19 vaccine doses.
Clearpol Inc. does not make any guarantees regarding the accuracy of the opinions provided on our platform. Please use your own judgement.
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