Checklist for Inpatient Communities During the COVID-19 Outbreak

MedBridge has worked with Shelley Bhola RN-BC, BSN, MSN, PHN, Infection Prevention Specialist, to put together resources for facilities and providers to use for education and preparation during the coronavirus outbreak:

1. Community Preparedness Guidelines for COVID-19 – Article
2. Checklist for Inpatient Communities During the COVID-19 Outbreak – Article [currently viewing] & Downloadable Flyer
3. COVID-19 Facility Policy – Downloadable Flyer
4. A Healthcare Worker’s Guide to Staying Healthy Amid the COVID-19 Pandemic – Article
5. Free Patient Education Videos: How to Protect Yourself Against the Coronavirus, and 5 Handwashing Steps You Should Follow

Key goals for the U.S. healthcare system in response to the COVID-19 outbreak are to:

• Reduce morbidity and mortality
• Minimize disease transmission
• Protect healthcare employees
• Preserve healthcare system functioning

Long-term care facilities have experience managing respiratory infections and outbreaks among residents and staff and should apply the same outbreak management principles to COVID-19. In addition, the following checklist will be initiated:

Identify Plan and Resources

1. Identify public health and professional resources.

• Local health department contact
• State health department contact
• State long-term care professional/trade association

2. Identify contacts for local, regional, or state emergency-preparedness groups, especially bioterrorism/communicable disease coordinators.

3. Identify contacts at local hospitals in preparation for the potential need to hospitalize residents or receive discharged residents from the hospital.

If a resident is referred to a hospital, coordinate transport with local hospital, local health department, and medical transport service/emergency medical service to ensure that the resident can be safely transported and received by the facility.

4. Perform surveillance to detect respiratory infections, including COVID-19.

• Assign one person to monitor public health updates from local and state public health departments.
• Implement protocol for monitoring of influenza-like-illness among residents and associates.
• Keep line listing on each unit and monitor 24/7.
• Assess all residents/staff with respiratory symptoms for:
  • Travel to area with COVID-19 in 14 days prior to onset of illness
  • Have family or visitors who have traveled to an area with COVID-19
  • Any diagnostic testing
• Symptoms of COVID-19 are cough, fever, and shortness of breath.

5. Immediately contact your local health department if a resident meets exposure and symptom criteria.

• Your local health department will help assess the situation and provide guidance for further actions.
• Specimens for COVID-19 will only be collected in the community if directed by the local health department.

Protecting Visitors and Associates

1. Educate all staff, residents, and family members of residents about COVID-19.

• Educate on potential harm from respiratory illnesses to nursing home residents as well as basic prevention and control measures for respiratory infections such as influenza and COVID-19.
• Include the following topics in education:
  • Hand hygiene – view and share our free video on 5 Handwashing Steps You Should Follow
  • Respiratory hygiene and cough etiquette, including sneezing/coughing into tissue or elbow, placing used tissues in a waste receptacle, and washing hands immediately after using tissues
  • Use of personal protective equipment (PPE) recommended when caring for those suspected or confirmed of having COVID-19, including gown, gloves, mask (or N95 respirator), and eye protection that covers the front and sides of the face.
  • Screening visitors for illness
  • Limiting visitors during outbreaks

2. Review, implement, and reinforce an infection control plan for preventing communicable disease among residents, visitors, and facility staff. The plan should include:

• A policy for when direct care staff should use standard, droplet ,and contact precautions for residents with symptoms of respiratory infection
• A plan for implementing respiratory hygiene throughout the community
• A plan for cohorting symptomatic residents or groups using one or more of the following strategies:
  • Confining symptomatic residents and exposed roommates to their rooms
  • Placing symptomatic residents together in one area of the community
  • Closing units where symptomatic and asymptomatic residents reside
  • Cohorting staff on either affected or non-affected units to prevent transmission between units
  • Canceling events in the community where many people come together
  • Cleaning and disinfecting high-touch surfaces with EPA-registered disinfectant with label claim of effectiveness against human coronavirus or merging viral pathogens

Download this prepared COVID-19 Facility Policy

Implementing Restrictions

1. Develop criteria and protocols for closing units or the entire community to new admissions when COVID-19 has been identified in the community.

• Inform discharge planners within your healthcare network that your community is closed to new admissions.
• If a section of the community will be closed but other units will remain open to new admissions, develop communications protocol to inform new residents of COVID-19 in the community.

2. Develop criteria and protocols for enforcing visitor limitations.

• If COVID-19 is identified in the surrounding community, determine a method to screen visitors for respiratory illness symptoms.
• Consider screening visitors for recent travel to high-risk areas with COVID-19 transmission.
• Post signs at the entry, the reception area, and throughout the community to help visitors, staff, and volunteers self-identify relevant symptoms and travel history.
• Educate visitors and family members not to visit the community if they are experiencing respiratory symptoms.

3. If visitors are allowed to enter the room of a resident with confirmed or suspected COVID-19, the facility will:

• Enact a policy defining what PPE should be used by visitors
• Before visitors enter the resident’s room, associates will provide instructions to visitors on hand hygiene, limiting surfaces touched, and appropriate use of PPE
• Maintain a record of all visitors who enter and exit the room
• Ensure visitors limit their movement within the community, avoiding the cafeteria and other common areas

Associate Health and Contingency Planning

1. Implement an occupational health plan with a non-punitive sick leave policy to address the needs of symptomatic staff, including:

• Staff, other caregivers, and volunteers should not report to the community if they are symptomatic with fever or respiratory symptoms and must report any such symptoms to human resources
• How to handle personnel who develop symptoms while at work
• Staff who do develop COVID-19 require two negative tests before isolation can be discontinued (this guidance may change as the situation evolves)
• How to accommodate personnel who need to care for ill family members
• Educate staff to self-assess and report symptoms of respiratory illness before reporting for work
• Identify staff who may be at higher risk for severe COVID-19 disease and attempt to assign them to unaffected units

2. Develop contingency staffing and resident placement plans.

• Identify minimum staffing needs and prioritize critical and non-essential services based on residents’ health status, functional limitations, disabilities, and essential facility operations.
• Contact your local healthcare coalition for guidance on altered standards of care in case residents need acute care and hospital beds are not available.
• Strategize how your community can help increase hospital bed capacity in the community.
• Establish memoranda of agreement with local hospitals for admission to the long-term care community of non-influenza residents to facilitate utilization of acute care resources for more seriously ill patients.

Take this checklist on the go with a PDF version: