Coronavirus Outbreak Management Plan

I. Purpose

To establish an Outbreak Management Plan for Coronavirus.

II. Scope

This Outbreak Management Plan will apply to all residents and staff.

III. Authority

This is established by the Emergency Planning Team with management approval.

IV. Procedure

A. Mitigation

The Emergency Planning Team or Management should establish a procedure for review of existing emergency plans on a regularly scheduled basis (at least annually) and with a specific outbreak, will review the policy based upon new information and criteria from the CDC, CMS and the DOH.

  • Review the plan to determine that the plan addresses when staff should use standard, droplet and contact precautions for residents with symptoms of respiratory infection.
  • Review and determine that the plan implements respiratory hygiene throughout the facility.
  • Review and determine if the plan identifies:
    • Symptomatic residents and who their contacts were that could have been exposed.
    • Place symptomatic residents in a designated area
    • If possible, close the unit that has symptomatic residents or place symptomatic residents in an area away from where asymptomatic residents reside. If needed, the unit can be divided by plastic barriers and a separate nurses station set up in the Activities room.
    • Cohort staff on either affected or non-affected units to prevent transmission.
    • Review monthly activities/develop an alternate plan to provide activities when the facility needs to limit group activities.
    • Deliver meals to units/rooms and consider closing large dining rooms.
    • Clean and disinfect high touch surfaces with FDA approved disinfection that meets the criteria for the novel Coronavirus.
  • The Emergency Planning Team or Management will perform a hazard vulnerability analysis review and threat assessment to determine necessary resources to respond to an active outbreak of the Coronavirus. The following will be notified.
    • Warren County Health Department
    • NJ State Health Department
    • State Communicable Disease Coordinator
    • Identify Hospitals to receive potential residents or those that must be discharged from the hospital
      • If resident must be transferred: coordinate with hospital, medical transport and health department to ensure safe transport and receipt by the facility.  (Resident must have a mask on and take all steps to reduce contamination to others)
      • Ensure residents transferred from the hospital are safely transported with a mask when entering the facility and placed in the appropriate unit for quarantine.
    • The community will close units or the entire facility to admissions when COVID-19 has been identified in the facility or as directed by the NJ DOH or CMS.
      • Inform the area hospitals or agencies (e.g. transferring hospitals) that the facility is closed to new admissions if there is an outbreak in the facility.
        • If the COVID-19 residents are on another unit and there is a unit open to new admissions, then the new resident will be informed of COVID-19 by the facility prior to admission.
      • Develop criteria and protocols for enforcing visitor limitations:
        • Due to the risk of COVID-19 to seniors, visitors will be asked not to visit when the COVID-19 virus has been identified in the facility. If the facility restricts visitors, the restriction policy will be posted and all residents/families appropriately notified.
        • If a visitor arrives and the facility has not closed to visitors, they must be screened prior to arrival as per the screening tool.
        • Signs will be posted at the entry, the reception area, and throughout the facility to help visitors, staff, volunteers, and contractors self-identify relevant symptoms and travel history.
        • If a visitor is allowed to enter the room of a confirmed or suspected COVID-19 case, the facility will provide training to the visitor on the PPE, instruction before they enter the room on hand hygiene, limiting surface touch, and appropriate use of PPE. (Only allowed in extreme circumstances.)
        • A log will be maintained of all visitors who enter and exit the room of a COVID-19 positive or presumed positive resident.
        • Visitors will be restricted in the facility and cannot enter the cafeteria, dining areas, or gathering areas. They will be escorted to the resident’s room if they are deemed appropriate to visit.
        • The Emergency Planning Team or Management will schedule and conduct drills / table-top exercises to test their response to a Coronavirus outbreak that includes all areas / personnel as well as local, regional, state, and private sector partners.
B. Preparedness
  • Assign an individual to monitor public health updates from local and state public health organizations and share these updates during each morning meeting.
  • Identify an area in the building where it will be possible to safely house any residents presenting symptoms of Coronavirus.
  • Monitor residents, potential admissions, staff, visitors and volunteers and track using the approved tracking tools. Create a list of who will perform these duties.  Prompt detection and effective triage and isolation of potentially infectious residents is essential to prevent unnecessary exposures among patients, healthcare personnel, and visitors at the facility.
  • As soon as possible, complete training for clinical staff regarding infection control procedures. Complete initial competencies for staff on PPE, hand-washing, self-monitoring and new screening for all staff and visitors. Review and sign off on the questionnaire.
    • Education will be on the Covid-19 and Outbreak Policy, procedures which includes basic, preventive and control measures for respiratory infections such as influenza and COVID-19. Update staff with new information that may be supplied by the CDC or DOH.
    • Re-educate staff on hand hygiene, cough etiquette and respiratory hygiene, including sneezing/coughing into tissue or elbow, wear a procedure mask as required, place used tissues in a waste receptacle and wash hands immediately after using tissues.
    • Re-educate staff on Personal Protective Equipment when caring for COVID-19 patients, including gown, gloves, mask (or respirator) and eye protection that covers the front and sides of the face.
  • The facility maintains PPE for the community that is secured within the site. RN supervisors or managers should have access to equipment for needs after business hours.
  • The community will maintain agency contracts for supplemental staff should the community have staff who become sick.
  • The community will identify staff to care for the infected or suspected patients.
  • A schedule of the minimum staffing needs prioritizes critical and nonessential services based on residents’ health status, functional limitations, disabilities and essential facility operations.
  • The hospital transfer agreements allow the facility to transfer to other levels of care or for non-influenza patients.
  • Contact local health care providers or Warren County Office of Emergency Management to check on PPE supplies should the community need more.
  • Plan to update families. (Designate staff personnel who will give updates to families.)
  • Staff policy is that the number of staff who enter the room of COVID-19 residents will be minimized to reduce cross contamination and containment. A schedule of all persons who care for or enter the care area of COVID-19 patients will be kept.
  • For all COVID-19 positive residents, the facility will identify all contacts with other residents and staff.
C. Individual / Employee / Agency / Contract / Companions Staff Screening

All individuals entering the site will be screened for the following:

  • International travel or domestic travel within the last 14 days to CDC-restricted states, countries, or within countries that have known outbreaks that may have caused exposure. Staff that has been on cruise ships, airplanes, or conferences where large groups gather may be restricted from work. (Staff may be required to quarantine at home for 14 days prior to returning to the community.) See the most updated screening form.
  • Signs or symptoms of a respiratory infection, such as fever, cough and sore throat, in rare cases has diarrhea; or has had contact with someone with or under investigation for COVID-19.
  • All individuals will be required to have their temperature taken upon entering the site.
  • If an individual’s temperature is greater than or equal to 100.6 they should not be permitted to remain in the facility.
  • Employees, agency, contractors and private aides and companions will be required to complete a screening and acknowledge that they will immediately report any signs and symptoms of respiratory infection to their Manager AND that they received CDC handouts related to infection preventing and donning/doffing PPE.
  • An employee presenting symptoms will:
    • Place a PPE mask, leave work, self-isolate at home, and contact their physician.
    • Inform the site CEO/Director of Nursing/Infection Preventionist, and include information on individuals, equipment, and locations the person came in contact with.
    • Contact and follow the local health department recommendations for next steps.
D. Clinical Presentation
  • Fever
  • Cough
  • Myalgia/Fatigue
  • Shortness of breath
  • Sore throat
  • Less commonly reported symptoms include sputum production, headache, hemoptysis, issues with lack of smell and diarrhea.
  • Risk factors for severe illness are not yet clear, although older patients and those with chronic medical conditions may be at higher risk for severe illness.
  • Incubation period is estimated from 2-14 days.
E. Outbreak Response
  • Notify the DOH, Local Health Department, Authorized Representative/POA/Family Members of the resident, agency staff and staff, Contractors (ex. Mobilex, Pharmacy). Contact and droplet precautions are implemented during care of residents with suspected coronavirus„ in addition to standard precautions used with all residents regardless of symptoms.
  • Droplet precautions are continued for (7) days after illness onset or until 24 hours after the resolution of fever and respiratory symptoms, whichever is longer. Precautions may be continued for longer periods based on clinical judgment.
  • Any patients who are symptomatic and have traveled internationally must be reported to the Department of Health. (See countries as updated by the CDC)
    • Any residents, visitors, medical personnel or vendors/ transportation personnel who have been on a cruise ship, attended large gatherings of individuals or been in confined areas such as planes, etc, may be required to wear a mask or be self-quarantined for 14 days.
  • Health care providers should contact their local/state health department immediately to notify them of patients with fever and lower respiratory illness who traveled internationally within 14 days of symptom onset. (Or other countries as updated by the CDC or CMS or NJ DOH).
  • Local and state public health staff will determine if the patient meets the criteria for a person under investigation (PUI) for COVID-19. The state and local health department will assist clinicians to collect, store, and ship specimens appropriately, including during afterhours or on weekends/holidays.
  • Staff who develop respiratory symptoms are to immediately report to the Infection Control Preventionist. Ill staff may not return to work until they have been afebrile longer than 72 hours (without antipyretic treatment) and respiratory symptoms have improved.
    • Once staff are sent home or called off, the Human Resources department must be notified immediately that the staff member has symptoms. A complete analysis of contacts must be performed and documented by Infection Control Preventionist.
    • Contractors, agency staff, volunteers must report to the Facility Infection Preventionist without delay if they have symptoms of the Flu. Analysis of Contacts must be performed and documented.
    • Once staff are educated on the risks and symptoms, the facility should identify those at high risk for COVID -19 and they should be assigned to an unaffected unit.
  • For patients with symptoms, place a facemask on the patient and isolate him/her in a room with the door closed. Only essential personnel should enter the room.
  • Implement staffing policies to minimize the number of healthcare professionals who enter the room. Facilities should keep a log of all persons who care for or enter the rooms or care area of these patients.
  • Health care professionals entering the room soon after a patient vacates the room should use respiratory and contact protection.
  • Staff should perform hand hygiene using Alcohol based sanitizer before and after all patient contact, contact with potentially infectious material, and before putting on and upon removal of PPE, including gloves. Hand hygiene in healthcare settings also can be performed by washing with soap and water for at least 20 seconds. If hands are visibly soiled, use soap and water before returning to Alcohol based sanitizer. Healthcare facilities should ensure that hand hygiene supplies are readily available in every care location.

Alternatives to Resident Visits

The Facility will offer other opportunities for residents and families to communicate which may include:

  • Virtual communication through methods of FaceTime and video conference.
  • Window visits set up by appointment.
  • Outdoor visitation in June 2020 and Indoor visitation in October 2020.
  • Updates to families about the facility actions through email, routine phone messages and mailed letters.
  • Personal communication to family by facility staff as needed.