The article below is a top story from this week's ACTION newsletter—Care Providers of Minnesota's weekly newsletter for members. The newsletter focuses on current legislative issues, regulations, long-term care trends, and other Association news. Each Thursday evening, it is delivered to your inbox. To sign up for ACTION, contact Lisa Foss Olson (952-851-2483). To learn more about membership, visit our Become a Member page.
CDC issues updated “Interim Infection Prevention & Control Recommendations for Healthcare Personnel During the Coronavirus Disease 2019 (COVID-19) Pandemic”
By Patti Cullen, CAE | May 12, 2023 | All members
On May 8, 2023, the Centers for Disease Control & Prevention (CDC) issued an update to their guidance: “Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the Coronavirus Disease 2019 (COVID-19) Pandemic” in advance of the ending of the Public Health Emergency (PHE) on May 11th.
This interim guidance has been updated based on currently available information about COVID-19 and the current situation in the United States. This guidance provides a framework for facilities to implement select infection prevention and control practices (e.g., universal source control) based on their individual circumstances (e.g., levels of respiratory virus transmission in the community).
This guidance is applicable to all US settings where healthcare is delivered (including nursing facilities and home health). This guidance is not intended for non-healthcare settings (e.g., restaurants) and not for persons outside of healthcare settings.
With the end of the public health emergency on May 11, 2023, the CDC will no longer receive data needed to publish community transmission levels for SARS-CoV-2. This metric informed CDC’s recommendations for broader use of source control in healthcare facilities.
As described in CDC’s Core IPC Practices, source control remains an important intervention during periods of higher respiratory virus transmission. Without the community transmission metric, healthcare facilities should identify local metrics that could reflect increasing community respiratory viral activity to determine when broader use of source control in the facility might be warranted (see related article and/or the appendix of this updated guidance).
Here are some highlights from the guidance but members are encouraged to read all three sections in their entirety.
1. Recommended routine infection prevention and control (IPC) practices during the COVID-19 pandemic
- Encourage everyone to remain up to date with all recommended COVID-19 vaccine doses.
- Establish a Process to Identify and Manage Individuals with Suspected or Confirmed SARS-CoV-2 Infection
- Implement Source Control Measures
- Source control is recommended for individuals in healthcare settings who:
- Have suspected or confirmed SARS-CoV-2 infection or other respiratory infection (e.g., those with runny nose, cough, sneeze); or
- Had close contact (patients and visitors) or a higher-risk exposure (HCP) with someone with SARS-CoV-2 infection, for 10 days after their exposure
- Source control is recommended more broadly as described in CDC’s Core IPC Practices in the following circumstances:
- By those residing or working on a unit or area of the facility experiencing a SARS-CoV-2 or other outbreak of respiratory infection; universal use of source control could be discontinued as a mitigation measure once the outbreak is over (e.g., no new cases of SARS-CoV-2 infection have been identified for 14 days); or
- Facility-wide or, based on a facility risk assessment, targeted toward higher risk areas (e.g., emergency departments, urgent care) or patient populations (e.g., when caring for patients with moderate to severe immunocompromise) during periods of higher levels of community SARS-CoV-2 or other respiratory virus transmission (See Appendix)
- Have otherwise had source control recommended by public health authorities (e.g., in guidance for the community when COVID-19 hospital admission levels are high)
- Perform SARS-CoV-2 Viral Testing on those with mild symptoms of COVID-19 or asymptomatic patients with close contact.
- Create a Process to Respond to SARS-CoV-2 Exposures Among HCP and Others. Healthcare facilities should have a plan for how SARS-CoV-2 exposures in a healthcare facility will be investigated and managed and how contact tracing will be performed.
2. Recommended infection prevention and control (IPC) practices when caring for a patient with suspected or confirmed SARS-CoV-2 infection.
The IPC recommendations described in this section (e.g., patient placement, recommended PPE) also apply to patients with symptoms of COVID-19 (even before results of diagnostic testing) and asymptomatic patients who have met the criteria for empiric Transmission-Based Precautions based on close contact with someone with SARS-CoV-2 infection. However, these patients should NOT be cohorted with patients with confirmed SARS-CoV-2 infection unless they are confirmed to have SARS-CoV-2 infection through testing. This is a detailed section that should be reviewed by your staff team, covering duration of precautions, placement, PPE, visitation and environmental infection control
3. Setting-specific considerations. In addition to the recommendations described in the guidance above, here are additional considerations for the settings listed below.
Nursing Homes
- Assign one or more individuals with training in IPC to provide on-site management of the IPC program
- This should be a full-time role for at least one person in facilities that have more than 100 residents or that provide on-site ventilator or hemodialysis services. Smaller facilities should consider staffing the IPC program based on the resident population and facility service needs identified in the IPC risk assessment.
- Stay connected with the healthcare-associated infection program in your state health department, as well as your local health department, and their notification requirements. Report SARS-CoV-2 infection data to National Healthcare Safety Network (NHSN) Long-term Care Facility (LTCF) COVID-19 Module. See Centers for Medicare & Medicaid Services (CMS) COVID-19 reporting requirements.
- Managing admissions and residents who leave the facility:
- Admission testing is at the discretion of the facility. Pros and cons of screening testing are described in Section 1.
- Residents who leave the facility for 24 hours or longer should generally be managed as an admission.
- Empiric use of Transmission-Based Precautions is generally not necessary for admissions or for residents who leave the facility for less than 24 hours (e.g., for medical appointments, community outings) and do not meet criteria described in Section 2.
- Placement of residents with suspected or confirmed SARS-CoV-2 infection
- Ideally, residents should be placed in a single-person room as described in Section 2.
- If limited single rooms are available, or if numerous residents are simultaneously identified to have known SARS-CoV-2 exposures or symptoms concerning for COVID-19, residents should remain in their current location.
- Responding to a newly identified SARS-CoV-2-infected HCP or resident
- When performing an outbreak response to a known case, facilities should always defer to the recommendations of the jurisdiction’s public health authority.
- A single new case of SARS-CoV-2 infection in any HCP or resident should be evaluated to determine if others in the facility could have been exposed.
- The approach to an outbreak investigation could involve either contact tracing or a broad-based approach; however, a broad-based (e.g., unit, floor, or other specific area(s) of the facility) approach is preferred if all potential contacts cannot be identified or managed with contact tracing or if contact tracing fails to halt transmission.
- Perform testing for all residents and HCP identified as close contacts or on the affected unit(s) if using a broad-based approach, regardless of vaccination status.
- Testing is recommended immediately (but not earlier than 24 hours after the exposure) and, if negative, again 48 hours after the first negative test and, if negative, again 48 hours after the second negative test. This will typically be at day 1 (where day of exposure is day 0), day 3, and day 5.
- Due to challenges in interpreting the result, testing is generally not recommended for asymptomatic people who have recovered from SARS-CoV-2 infection in the prior 30 days. Testing should be considered for those who have recovered in the prior 31-90 days; however, an antigen test instead of a nucleic acid amplification test (NAAT) is recommended. This is because some people may remain NAAT positive but not be infectious during this period.
- Empiric use of Transmission-Based Precautions for residents and work restriction for HCP are not generally necessary unless residents meet the criteria described in Section 2 or HCP meet criteria in the Interim Guidance for Managing Healthcare Personnel with SARS-CoV-2 Infection or Exposure to SARS-CoV-2, respectively. However, source control should be worn by all individuals being tested.
- In the event of ongoing transmission within a facility that is not controlled with initial interventions, strong consideration should be given to use of Empiric use of Transmission-Based Precautions for residents and work restriction of HCP with higher-risk exposures. In addition, there might be other circumstances for which the jurisdiction’s public authority recommends these and additional precautions.
- If no additional cases are identified during contact tracing or the broad-based testing, no further testing is indicated. Empiric use of Transmission-Based Precautions for residents and work restriction for HCP who met criteria can be discontinued as described in Section 2 and the Interim Guidance for Managing Healthcare Personnel with SARS-CoV-2 Infection or Exposure to SARS-CoV-2, respectively.
- If additional cases are identified, strong consideration should be given to shifting to the broad-based approach if not already being performed and implementing quarantine for residents in affected areas of the facility. As part of the broad-based approach, testing should continue on affected unit(s) or facility-wide every 3-7 days until there are no new cases for 14 days.
- If antigen testing is used, more frequent testing (every 3 days), should be considered.
- Indoor visitation during an outbreak response:
- Facilities should follow guidance from CMS about visitation.
- Visitors should be counseled about their potential to be exposed to SARS-CoV-2 in the facility.
- If indoor visitation is occurring in areas of the facility experiencing transmission, it should ideally occur in the resident’s room. The resident and their visitors should wear well-fitting source control (if tolerated) and physically distance (if possible) during the visit.
Assisted Living, Group Homes and Other Residential Care Settings (excluding nursing homes)
In general, long-term care settings (excluding nursing homes) whose staff provide non-skilled personal care* similar to that provided by family members in the home (e.g., many assisted livings, group homes), should follow community prevention strategies based on COVID-19 hospital admission levels, similar to independent living, retirement communities or other non-healthcare congregate settings. Residents should also be counseled about strategies to protect themselves and others, including recommendations for source control if they are immunocompromised or at high risk for severe disease. CDC has information and resources for older adults and for people with disabilities.
Visiting or shared healthcare personnel who enter the setting to provide healthcare to one or more residents (e.g., physical therapy, wound care, intravenous injections, or catheter care provided by home health agency nurses) should follow the healthcare IPC recommendations in this guidance. In addition, if staff in a residential care setting are providing in-person services for a resident with SARS-CoV-2 infection, they should be familiar with recommended IPC practices to protect themselves and others from potential exposures including the hand hygiene, personal protective equipment and cleaning and disinfection practices outlined in this guidance.
*Non-skilled personal care consists of any non-medical care that can reasonably and safely be provided by non-licensed caregivers, such as help with daily activities like bathing and dressing; it may also include the kind of health-related care that most people do themselves, like taking oral medications. In some cases where care is received at home or a residential setting, care can also include help with household duties such as cooking and laundry.
Patti Cullen, CAE | President/CEO | pcullen@careproviders.org | 952-851-2487