MANHA’s 2022 Annual Convention

June 5-8, 2022: Mandatory PPE – People Pride Endurance
Location: Camden on the Lake, Lake Ozark

Missouri Association of Nursing Home Administrators is pleased to invite you to attend our 2022 Annual Convention. This conference is a focus on the Administrators and staff after an unprecedented 2 years. The goal of this conference is to provide meaningful, forward thinking, and real-time education to pave the path forward while acknowledging the past and working through hard topics, together.

Updated CDC Guidance on Antigen Testing in Long Term Care Facilities

The Centers for Disease Control and Prevention (CDC) recently updated the following healthcare Infection, Prevention and Control (IPC) guidance document: SARS-CoV-2 Antigen Testing in Long Term Care Facilities | CDC. The core recommendations in this guidance have not significantly changed. The page was updated to:

Updated CDC Guidance

On February 2, 2022, CDC updated the following healthcare infection prevention and control (IPC) guidance documents: Infection Control: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) | CDC and Interim Infection Prevention and Control Recommendations to Prevent SARS-CoV-2 Spread in Nursing Homes | CDC.

Updates were made in these guidance documents to align with prior updates made for healthcare personnel with higher-risk exposures in the Interim Guidance for Managing Healthcare Personnel with SARS-COV-2 Infection or Exposure to SARS-CoV-2, which was released on December 23, 2021.

A review of the updates was given on a recent Clinician Outreach and Communication Activity (COCA) Call, which was recorded and is accessible here: Webinar January 13, 2022 – Updates to CDC’s COVID-19 Quarantine and Isolation Guidelines in Healthcare and Non-healthcare Settings. Additionally, a brief summary of the updates can be found below. Please consult the guidance documents for the full recommendations.

Vaccination status

Use of N-95 respirators

*Please see complete guidance for full personal protective equipment recommendations

  • CDC continues to recommend gown, gloves, eye protection and a NIOSH-approved N95 or equivalent or higher-level respirator when caring for patients known or suspected to be infected with SARS-CoV-2.
  • In counties with substantial to high community transmission, a NIOSH-approved N95 or equivalent or higher-level respirator is also recommended instead of a facemask when caring for patients not known or suspected to have SARS-CoV-2 infection in the following higher-risk situations:
    • All aerosol-generating procedures;
    • Higher-risk surgical procedures;
    • These respirators can also be used by HCP in situations where additional risks for infection are present, such as caring for a patient who is not up to date with all recommended COVID-19 vaccine doses, the patient is not able to wear source control, and the area is poorly ventilated. They may also be used if healthcare-associated SARS-CoV-2 transmission is identified.

 Viral testing

  • CDC continues to emphasize that anyone with even mild symptoms of COVID-19, regardless of vaccination status, should receive a viral test as soon as possible.
  • Asymptomatic patients with close contact with someone with SARS-CoV-2 infection, regardless of vaccination status, should have a series of two viral tests for SARS-CoV-2 infection.
    • Generally, test immediately (but not earlier than 24 hours after the exposure) and, if negative, again 5-7 days after the exposure.
  • Testing is not generally necessary for asymptomatic people who have recovered from SARS-CoV-2 infection in the prior 90 days; however, if tested, an antigen test instead of a nucleic acid amplification test (NAAT) is recommended as some people may remain NAAT positive after they are no longer infectious.

Criteria to end isolation for patients with SARS-CoV-2 infection cared for in a healthcare facility

  • Asymptomatic patients or those with mild to moderate illness and who are not moderately to severely immunocompromised: manage with recommended precautions for 10 days after their symptoms first appeared.
  • Patients with severe to critical illness and who are not moderately to severely immunocompromised: manage with recommended precautions until at least 10 days and up to 20 days have passed since symptoms first appeared.
  • Symptomatic and asymptomatic patients who are moderately to severely immunocompromised: a test-based strategy and (if available) consultation with an infectious disease specialist or other expert is recommended to determine when these patients can be released from isolation.

Quarantine for patients:

  • Empiric use of Transmission-Based Precautions (quarantine) is recommended for patients who have had close contact with someone with SARS-CoV-2 infection if they are not up to date with all recommended COVID-19 vaccine doses. Duration of quarantine is described in the guidance.
  • Quarantine is not generally needed following close contact with someone with SARS-CoV-2 infection for asymptomatic patients who are up to date on all recommended COVID-19 vaccine doses or who have recovered from infection in the prior 90 days. Potential exceptions are described in the guidance.

Visitation

  • Even if they have met community criteria to discontinue isolation or quarantine, visitors should not visit if they have any of the following and have not met the same criteria used to discontinue isolation and quarantine for patients (typically until 10 days after last exposure or onset of symptoms has passed):

1) A positive viral test for SARS-CoV-2,
2) Symptoms of COVID-19, or
3) Close contact with someone with SARS-CoV-2 infection

  • If visitation cannot be postponed the visitor might be subject to additional precautions.

This guidance on infection prevention and control will continue to be refined as additional information becomes available.

Visitation in Long-Term Care Facilities (RCF, ALF, ICF and SNFs)

SLCR has received several questions recently regarding visitation in long-term care facilities. All previous guidance provided by DHSS regarding visitation is no longer in effect. No state waivers are in place regarding regulatory or statutory requirements related to visitation. Section 198.088.6(K), RSMo states, “Each resident admitted to the facility may communicate, associate and meet privately with persons of his choice, unless to do so would infringe upon the rights of other residents.” State regulations also require facilities to follow appropriate infection control procedures. To balance these two requirements, all long-term care facilities (RCF, ALF, ICF and SNF) should follow CDC guidance related to visitors: https://www.cdc.gov/coronavirus/2019-ncov/hcp/long-term-care.html#anchor_1631030962190. The CDC guidance points facilities to CMS’ memo for additional information related to visitation. Certified facilities are required to follow CMS guidelines. Although state licensed only facilities are not required to follow the requirements in QSO 20-39 NH, DHSS highly encourages them to use the memo and FAQs as a standard of practice to ensure safe visitation occurs in their long-term care community.

CMS has developed a Frequently Asked Questions document to address the questions received regarding visitation in Nursing Homes. This additional information is provided to help residents, families and providers ensure that safe visitation can occur. The FAQs can be found on the cms.gov emergencies page here and also in QSO-20-39-NH REVISED.

CDC Health Advisory: Using Therapeutics to Prevent and Treat COVID-19

Please see the CDC Health Advisory, number 461, dated 12/31/2021, entitled “Using Therapeutics to Prevent and Treat COVID-19.”

Missouri healthcare providers – please contact your Local Public Health Agency or the Missouri Department of Health and Senior Services’ (DHSS’) Bureau of Communicable Disease Control and Prevention at 573-751-6113 or 800-392-0272 (24/7) with questions regarding this CDC Health Advisory.

UPDATED CDC Guidelines for Isolation/Quarantine

Facility Employees/Healthcare Personnel

All Residential Care Facilities, Assisted Living Facilities, Intermediate Care Facilities, Skilled Nursing Facilities should follow current Centers for Disease Control and Prevention (CDC) Guidelines related to managing healthcare personnel who have tested positive or an exposure to COVID-19.

Interim Guidance for Managing Healthcare Personnel with SARS-CoV-2 Infection or Exposure to SARS-CoV-2 | CDC

For Certified SNF/ICF providers, current CMS guidance QSO 20-38 states “If COVID-19 is confirmed, staff should follow Centers for Disease Control and Prevention (CDC) guidelines “Criteria for Return to Work for Healthcare Personnel with SARS­CoV2 Infection”, therefore, homes can immediately change policies and procedures to incorporate the updated changes from the CDC.

 

General Population/Visitors

All Residential Care Facilities, Assisted Living Facilities, Intermediate Care Facilities, Skilled Nursing Facilities should follow current Centers for Disease Control and Prevention (CDC) Guidelines related to quarantine and isolation for visitors. Facilities should be aware of and follow the updated quarantine/isolation guidelines for visitors in your communities as well.

CDC Updates and Shortens Recommended Isolation and Quarantine Period for General Population | CDC Online Newsroom | CDC

For Certified SNF/ICF providers, current CMS guidance QSO 20-39 states “Visitors who have a positive viral test for COVID-19, symptoms of COVID-19, or currently meet the criteria for quarantine, should not enter the facility. Facilities should screen all who enter for these visitation exclusions. Homes can immediately change policies and procedures to incorporate the updated changes from the CDC.

COVID Testing Resources

State Orders for Abbott BinaxNOW Tests

Missouri is experiencing constrained supplies of the BinaxNOW COVID antigen test cards. Thus, effective September 9, 2021, DHSS is implementing a revised BinaxNOW test ordering cadence in order to conserve supply and assure the optimum availability of BinaxNOW COVID antigen tests for all users. Until further notice, please order no more than two weeks supply of BinaxNOW tests for use by your facility or organization. If our supply allows larger quantities to be ordered, we will modify this process accordingly at that time and notify all users. https://health.mo.gov/living/healthcondiseases/communicable/novel-coronavirus/testing-resources.php

 

To Reinstate Direct Shipments of Abbott BinaxNOW from the Federal government:

Providers should email their facility information, shipping address and the BinaxNOW delivery Point of Contact for the facility and request to be added back onto the direct shipment list to Binax.Team@hhs.gov. Please be aware reinstatement depends upon available supply of tests to the Federal government and this can take several weeks to begin receiving shipments again.

 

Reimbursement for OUTBREAK Testing

A reminder that in order to furnish immediate aid and relief in response to the state of emergency due to the spread of COVID-19, the State of Missouri has made some funds from the Coronavirus Relief Fund available to Missouri Long-Term Care facilities with COVID-19 Outbreaks. These funds are available to Long-Term Care facilities that experience an outbreak (one or more positive cases) and are conducting base-line facility testing and some immediate follow-up testing in order to contain outbreaks. For more information: https://apps.dss.mo.gov/LongTermCareCovid19Invoices/.

Missouri Nursing Home Advisory Council – Infection Preventionist Roadmap Series

Missouri Nursing Home Advisory Council has created another installment in their Infection Preventionist Roadmap Series for long-term care facilities. As we continue with our “IP Tip Sheets” to support the Infection Preventionist (IP) in their central role of leading the Infection Prevention & Control Program, we shift our focus to linen management. This sometimes-overlooked area of infection control can leave a facility vulnerable to an infection source. Having good procedures and policies in place that include infection control protocols is key to a successful linen management program.

Please see the Nursing Home Advisory Council IP Tip Sheet 4th Edition.

New QIPMO Newsletter – November 2021

The Quality Improvement Program for Missouri (QIPMO) has published MDS Tips and Clinical Pearls (Volume 9, Issue 1).

In this issue:

  • 5-Star Staff
  • Tube Feeding Monitoring
  • Giving Thanks
  • Accounts Payable
  • Red Light, Orange Light, Yellow Light, Blue?
  • More Than a Thousand Words

Please visit QIPMO’s website here for this and other previous newsletters.

CMS Memo QSO-20-38-NH: Interim Final Rule (IFC), CMS-3401-IFC, Additional Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency related to Long-Term Care (LTC) Facility Testing Requirements

Long-Term Care (LTC) Facility COVID-19 Testing Requirements (QSO 20-38-NH, revised 9/10/2021)

Please read the memo carefully. CMS has revised testing requirements for nursing homes including testing of symptomatic residents and staff, and routine testing of staff. Two major changes are:

  • Facilities now have two options to conduct outbreak testing, through either a contact tracing or broad-based testing approach. See Table 1.
  • Routine staff testing is now based on the facility’s county level of community transmission instead of county test positivity rate. The link to determine county level of community transmission is in the memo. The frequency of testing has also been updated. See Table 2.

 

Table 1: Testing Summary

Testing Trigger

Staff

Residents

Symptomatic individual identified

Staff, vaccinated and unvaccinated, with signs or symptoms must be tested.

Residents, vaccinated and unvaccinated, with signs or symptoms must be tested.

Newly identified COVID- 19 positive staff or resident in a facility that can identify close contacts

Test all staff, vaccinated and   unvaccinated, that had a higher-risk exposure with a COVID-19 positive individual.

Test all residents, vaccinated and unvaccinated, that had close contact with a COVID-19 positive individual.

Newly identified COVID- 19 positive staff or resident in a facility that is unable to identify close contacts

Test all staff, vaccinated and unvaccinated, facility-wide or at a group level if staff are assigned to a specific location where the new case occurred (e.g., unit, floor, or other specific area(s) of the facility).

Test all residents, vaccinated and unvaccinated, facility-wide or at a group level (e.g., unit, floor, or other specific area(s) of the facility).

Routine testing

According to Table 2 below

Not generally recommended

 

Table 2: Routine Testing Intervals by County COVID-19 Level of Community Transmission

Level of COVID-19 Community

Transmission

Minimum Testing Frequency of

Unvaccinated Staff+

Low (blue)

Not recommended

Moderate (yellow)

Once a week*

Substantial (orange)

Twice a week*

High (red)

Twice a week*

+Vaccinated staff do not need to be routinely tested.

 

Please see the full memo for complete details at https://www.cms.gov/medicareprovider-enrollment-and-certificationsurveycertificationgeninfopolicy-and-memos-states-and/interim-final-rule-ifc-cms-3401-ifc-additional-policy-and-regulatory-revisions-response-covid-19-0.

Advoque Safeguard Issued Respirator User Notice

On September 17, 2021, Advoque Safeguard issued a user notice identifying 6 very small lots of the model SG100 N95 Particulate Filtering Respirator (TC-84A-9284) that require additional sampling for pressure testing. Any individual or organization in possession of any ASG100 product in the 6 lots should isolate the product and contact Advoque Safeguard Quality Control (qc@advoquesafeguard.com).

More information can be found on the NIOSH Manufacturer Notice webpage: https://www.cdc.gov/niosh/npptl/usernotices/noticesmanufact.html under Advoque Safeguard.

Revocation of NIOSH Certification

As of August 13, 2021, any Shanghai Dasheng Health Products Manufacture Co., Ltd. respirator with a NIOSH approval label containing a revoked approval number is no longer NIOSH-approved and cannot be manufactured, assembled, sold, or distributed.

See the link below to find the approval numbers of the respirators that have been de-certified. The approval number starts with TC-84A. If you can’t find this number on the respirator or its packaging, it was never NIOSH approved in the first place and shouldn’t be used, but if it has any of the listed TC numbers in the link below on the respirator itself or its packaging, you should discontinue use immediately and remove from use any that have been distributed.

https://www.cdc.gov/niosh/npptl/resources/pressrel/letters/respprotect/CA-2021-1038.html

Infection Control Assessment and Response Project

QIPMO has collaborated with the Missouri Department of Health and Senior Services (DHSS) in response to the novel Coronavirus known as COVID-19. In doing so, QIPMO has formed a new Infection Control Assessment and Response (ICAR) team with a primary goal of assisting Missouri Long-Term Care Facilities to navigate the challenges of the COVID-19 pandemic and other infectious diseases.

Please see the flyer or visit the following QIPMO webpage – https://nursinghomehelp.org/icar-project/.

Personal Protective Equipment (PPE)

Missouri has limited PPE reserves to assist in filling these critical needs and will prioritize healthcare providers providing direct care to confirmed or suspected COVID patients. Note requests should only be submitted after all normal supply chains, including the Missouri COVID Supply Solution, have been exhausted and providers have a supply of twenty-one days or less on hand.

Please be sure to describe the urgent need for PPE and your situation in the comments on the form.
https://health.mo.gov/living/healthcondiseases/communicable/novel-coronavirus/ppe.php

Missouri Nursing Home Advisory Council – Infection Preventionist Roadmap Series

The Missouri Nursing Home Advisory Council is pleased to provide the third iteration of the “IP Tip Sheets” intended to assist and support the Infection Preventionist (IP) in the long-term care setting. In the first installment of the “IP Tip Sheets” series, the antibiotic stewardship aspects of the Infection Prevention & Control Program (IPCP), with the Infection Preventionist leading the team in a successful IPCP was explored. In the second installment, the focused was on the system of prevention, identification, reporting, investigating, and controlling infections. For this edition, the annual activities and reviews performed by the IP will be highlighted. Please see the MO Nursing Home Advisory Council IP Tip Sheet.

Monthly Infection Control and Prevention Webinar Series: What you need to know to keep you, your patients and community safe.

June 2021 -December 2022 – 2nd Tuesday of each month from 12-1 p.m.: ICP Monthly Webinar Series

June 10 – Inaugural Webinar: Vaccines are Safe – How we know!
Lynelle Phillips, MPH, RN, Assistant Teaching Professor, Department of Public Health, School of Health Professions, Extension Service Nurse Specialist, University of Missouri, Columbia

  • General rules of vaccines
  • FDA approval process and Emergency Use Authorization Use (EUA) process
  • How were we able to get a vaccine to market in such a short time and still cut no corners?
  • Compare the different vaccines – safety and efficacy
  • Is the lesser protection by J&J significant enough to be important? J&J Case Study.

 

July 8 – How do COVID vaccines affect immunity to COVID?
Taylor Nelson, DO, Infectious Disease, Internal Medicine, University of Missouri Health Care, Columbia. Board Certified by the American Board of Internal Medicine/Infectious Disease

  • Natural immunity vs vaccine-induced immunity – which is best?
  • How long does the vaccine protect me?
  • What is Herd immunity and is it reasonable to expect we will ever achieve it?
  • If I’ve had COVID, why get vaccinated?
  • To boost or not to boost?
  • I’m young, isn’t it less risky to take chance with COVID than the vaccine?

 

August 10 – Environmental Health: Air Purification and Quality
Loie Couch, RN, BS, CIC, FAPIC, Infection Prevention Specialist, Barnes Jewish Christian (BJC) Hospital, St. Louis

  • Functions of a ventilation system
  • Benefits and limitations of bi-polar ionization
  • Minimum filtration requirements
  • Apply filtration flexibility on a space-by-space approach
  • Appropriate use of UV light disinfection and accompanying hazards
  • Visible light disinfection and its appropriate use and considerations

New QIPMO Newsletter – May 2021

The Quality Improvement Program for Missouri (QIPMO) has published MDS Tips and Clinical Pearls – Volume 8, Issue 3.

In this issue:

  • Embracing Diversity in Our Homes
  • Can You See the Light??
  • Just for You: QIPMO Infection Control Manual
  • No-Nose Gang
  • OSHA in tha’ House!
  • Maintaining Life Safety Code Compliance
  • Person-Centered Activities

Please visit QIPMO’s website here for this and other previous newsletters.

Updated Guidelines for the Anti-SARS-CoV-2 Monoclonal Antibody Treatment of COVID-19

Health Advisory 4-13-22

SARS-CoV-2, virus causing coronavirus disease 2019 (COVID 19), has been evolving over time, resulting in genetic variation in the population of circulating viruses across the world, including the United States. Some of those variations in viral genome can cause resistance to one or more of the monoclonal antibodies (mAb) therapies authorized to treat COVID-19. The ongoing surveillance of human and sewage samples by the Missouri Department of Health and Senior Services (DHSS) indicates rise in variant SARS-CoV-2 in Missouri, similar to other states. This DHSS Health Advisory urges health care providers in Missouri to follow newly updated COVID-19 mAB treatment guidelines issued by the National Institute of Health (NIH).

Please view the full Health Advisory for all details – Updated Guidelines for the Anti-SARS-CoV-2 Monoclonal Antibody Treatment of COVID-19 (4.13.21).

Missouri Nursing Home Advisory Council – Infection Preventionist Roadmap Series

Missouri Nursing Home Advisory Council has created a second installment in their Infection Preventionist Roadmap Series for long-term care facilities. This second installment will focus on the system of prevention, identification, reporting, investigating, and controlling infections. See the Tip Sheet.

MU Nursing Outreach Presents: Free Online Healthcare-Associated Infection Courses

Long-Term Care Facilities and Visitation

As we anxiously await guidance from CDC and CMS on changes, they will recommend and/or require of long-term care communities related to testing, visitation, quarantine, etc. – a reminder that homes should use previous visitation guidance to support opening up their communities to visitors. This week, the CMS spreadsheet of county positivity rates shows MO with 63 green, 49 yellow and 3 red counties. Homes in green and yellow counties should allow visitation according to the core principles of COVID-19 infection prevention and facility policies, if they are not in outbreak status. As soon we receive updated guidance, we will communicate the information via the long-term care facility listserv. Keep in mind DHSS has issued guidelines- not regulatory requirements related to visitation. You know your long-term care community and can best assess and make a plan to help residents reconnect with loved ones based on their wants/needs, availability of PPE, staffing, etc.

Additional guidance related to frequent questions we receive:

 

COVID recovered in past 3 months

If a resident has tested positive and has recovered (no longer on transmission based precautions) in the past 90 days, CDC guidance states they do not need to quarantine or get tested again for up to 3 months as long as they do not develop symptoms again. https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/quarantine.html Homes can use this guidance in developing policies related to visitation and quarantine for residents as well to help expand visitation within their communities and to allow residents to resume some normalcy in their routines.

For residents that have had COVID in the past 3 months and are off of transmission based precautions, they would not need to quarantine if they left for a home visit or went out for dinner- based on CDC guidance for quarantine. We encourage facilities, families and residents to continue to use the infection control practices outlined in the attached memo. Even though someone has had COVID- we do not know a lot about reinfections and those measures (mask, social distancing, and good hand hygiene) help protect from influenza as well.

 

Home Visits and Outings

If a resident chooses to leave the facility to visit family or for an outing, we recommend nursing homes use the recommendations from the holiday leave guidance when they return to the nursing home:

  • Screen and increase monitoring for signs and symptoms.
  • Test a resident for COVID-19 if signs or symptoms are present or if a resident or their family reports possible exposure to COVID-19 while outside the nursing home. A nursing home may also opt to test residents without signs or symptoms if they leave the nursing home frequently or for a prolonged length of time, such as over 24 hours. For more information on testing guidelines, see CMS memorandum QSO-20-38-NH.
  • Place the resident on transmission-based precautions (TBP) if the resident or family member reports possible exposure to COVID-19 while outside of the nursing home, or if the resident has signs or symptoms of COVID-19 upon return. Please note that residents and loved ones should report to the nursing home staff if they have had any exposure to COVID-19 while outside of the nursing home.
  • Consider placing residents on Transmission Based Precautions BP if they were away from the nursing homes for more than 24 hours.

https://www.cms.gov/files/document/covid-facility-holiday-recommendations.pdf

https://health.mo.gov/living/healthcondiseases/communicable/novel-coronavirus/pdf/ltcf-holiday-guidance.pdf

 

Vaccination and Infection Control measures

At this time, there are still many questions unanswered regarding vaccination that make infection control changes uncertain right now. Current CDC can be found here: https://www.cdc.gov/vaccines/covid-19/toolkits/long-term-care/index.html.

Vaccination is one important tool (not the only) in our tool belt to address COVID-19 infections. Vaccinating healthcare personnel and residents is essential to helping prevent individuals (who may not be able to recover) from getting COVID-19. For long-term care facilities, vaccinations are vital to protecting healthcare capacity. Staff who are sick cannot work and provide the necessary case and services to residents to ensure their health and safety.

The toolkit includes some helpful information for staff and residents/loved ones regarding the vaccine as well.

https://www.cdc.gov/vaccines/covid-19/toolkits/long-term-care/downloads/answering-staff-questions.pdf

https://www.cdc.gov/vaccines/covid-19/toolkits/long-term-care/downloads/answering-residents-loved-ones-questions.pdf

 

Visitation Guidance 9-22-20
CMS Memo – Nursing Home Visitation – COVID-19

New QIPMO Newsletter – February 2021

The Quality Improvement Program for Missouri (QIPMO) has published MDS Tips and Clinical Pearls – Volume 8, Issue 2.

In this issue:

  • To Vaccinate or Not to Vaccinate
  • During These Depressive Times
  • The Role of the Charge Nurse
  • Infection Control Assessment and Response
  • Housekeepers: Another Important Team Member
  • Employee Engagement
  • No More BUTS!

Please visit QIPMO’s website here for this and other previous newsletters.