Category: Infection Control & Prevention

Missouri Nursing Home Advisory Council – Infection Preventionist Roadmap Series

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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

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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

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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

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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

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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

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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)

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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

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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.

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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

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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

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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

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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

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Long-Term Care Facilities and Visitation

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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

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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.

Statewide Project to Test Wastewater for COVID Virus – Recruitment of 20 Long-Term Care Communities

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Since May 2020, the Missouri Department of Health and Senior Services (DHSS), Department of Natural Resources (DNR) and researchers at the University of Missouri – Columbia have been collaborating on a statewide project to test wastewater for genetic markers of SARS-CoV-2, the virus that causes COVID-19. The project recently received new funding through a grant from National Institutes of Health (NIH) to expand wastewater testing to additional congregate living facilities. Public health experts have identified wastewater testing as a useful tool for early detection of outbreaks, even as vaccination efforts progress and clinical testing improves. Please see the letter regarding information about this project and information on recruiting 20 congregate living communities to participate in an expansion of this testing. Ideally, communities would have 50 or more residents who contribute to the sewer system.

Please contact the Department of Health and Senior Services Environmental Public Health Tracking Team at EPHTN@health.mo.gov or 866-628-9891 or 573-751-6102 to express interest in the project or to ask any additional questions. Communities who are interested will receive a follow-up contact from the Missouri Department of Natural Resources to determine if their sewer system will work for this type of testing.

COVID-19 Vaccine, TB testing, and Co-administration with other Vaccines

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We have received a couple emails regarding this, so passing along CDC guidelines on receiving COVID vaccine after/before flu vaccines, TB testing, etc.:

https://www.cdc.gov/vaccines/covid-19/info-by-product/clinical-considerations.html

Interpretation of tuberculosis test results in vaccinated persons

Inactive vaccines do not interfere with tuberculosis (TB) test results. There is no immunologic reason to believe either a Tuberculin Skin Test (TST) (administered by intradermal placement of 0.1 cc of purified protein derivative) or blood draw for interferon gamma release assay (IGRA) would affect the safety or effectiveness of mRNA COVID-19 vaccines. We have no data to inform the impact of the COVID-19 mRNA vaccines on either TB test for infection (i.e., TST or IGRA).

For healthcare personnel or patients who require baseline TB testing (at onboarding or entry into facilities) at the same time they are to receive an mRNA COVID-19 vaccine:

  • Perform TB symptom screening on all healthcare personnel or patients.
  • If utilizing the IGRA, draw blood for interferon gamma release assay prior to COVID-19 vaccination.
  • If utilizing the TST, place prior to COVID-19 vaccination.
  • If vaccination has been given and testing needs to be performed, defer TST or IGRA until 4 weeks after COVID-19 vaccine 2-dose completion.
    • All potential recipients of COVID-19 vaccination should weigh the risks and benefits of delaying TST/IGRA with their providers.

If a facility has a concern regarding delaying the TST or IGRA, because of vaccination- then they can rely on the state waivers currently in place to delay the TB test, if necessary.

Another question we have received has been regarding CDC guidance related to co-administration with other vaccines.

Coadministration with other vaccines

Given the lack of data on the safety and efficacy of mRNA COVID-19 vaccines administered simultaneously with other vaccines, the vaccine series should routinely be administered alone, with a minimum interval of 14 days before or after administration with any other vaccine. However, mRNA COVID-19 and other vaccines may be administered within a shorter period in situations where the benefits of vaccination are deemed to outweigh the potential unknown risks of vaccine coadministration (e.g., tetanus toxoid-containing vaccination as part of wound management, measles or hepatitis A vaccination during an outbreak) or to avoid barriers or delays to mRNA COVID-19 vaccination (e.g., in long-term care facility residents or healthcare personnel who received influenza or other vaccinations prior to/upon admission or onboarding). If mRNA COVID-19 vaccines are administered within 14 days of another vaccine, doses do not need to be repeated for either vaccine.

COVID Vaccinations and Infection Control

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SLCR has received many questions regarding COVID-19 vaccinations and the impact those vaccinations will have on infection control guidelines. 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.

LTCF Staff pdf
LTCF Residents & Loved Ones pdf

CMS Memo: QSO 20-31-ALL: Revised COVID-19 Survey Activities, CARES Act Funding, Enhanced Enforcement for Infection Control deficiencies, and Quality Improvement Activities in Nursing Homes

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CMS has revised the criteria requiring states to conduct focused infection control surveys due to the increased availability of resources for the testing of residents and staff and factors related to the quality of care. In addition, CMS has provided Frequently Asked Questions related to health, emergency preparedness and life-safety code surveys.

See the memo for details.

COVID-19 Vaccine Safety: A Fireside Chat with CMS, CDC, and front line staff and providers 

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COVID-19 Vaccine Safety: A Fireside Chat with CMS, CDC, and front line staff and providers
Wednesday, 6, 2021, at 3:00 pm (Central Time)

Join The Centers for Medicare & Medicaid Services (CMS), the Centers for Disease Control and Prevention (CDC) for a fireside chat on vaccine safety. This is the second discussion in a special series, a part of the CMS National Nursing Home Stakeholder Call Series, aimed at addressing staff questions and concerns about the new COVID-19 vaccines. Each session will be moderated by CMS with speakers from CDC and representatives of front line staff and providers.

This chat will continue to address myths surrounding vaccine danger with the following panelist:

  • Dr. Lee Fleisher, CMS Chief Medical Officer and Director, Center for Clinical Standards and Quality (CMS)
  • Dr. Amanda Cohn, Chief Medical Officer (Acting), Office of Vaccine Policy, Preparedness, and Global Health, Office of the Director (CDC)
  • Cassandra Lowe, Certified Nursing Assistant (CNA)

Preparing for the call:

Target Audience: Nursing Home Frontline staff, Chief Nursing Officers

Register in advance for this webinar (After registering, you will receive a confirmation email containing information about joining the webinar): https://cms.zoomgov.com/webinar/register/WN_VQnfc77zTaOho3-yYrtGUAA

Infection Control Assessment and Response Project

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INFECTION CONTROL ASSESSMENT AND RESPONSE PROJECT: A COLLABORATION BETWEEN THE MISSOURI DEPARTMENT OF HEALTH AND SENIOR SERVICES AND THE QUALITY IMPROVEMENT PROGRAM FOR MISSOURI NURSING HOMES

The Quality Improvement Program for Missouri’s Nursing Homes (QIPMO) is partnering 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.

See the New Release for more information.

CDC Guidance and Updates

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The CDC has issued the following guidance:

Testing and Management Considerations for Nursing Home Residents with Acute Respiratory Illness Symptoms when SARS-CoV-2 and Influenza Viruses are Co-circulating

https://www.cdc.gov/flu/professionals/diagnosis/testing-management-considerations-nursinghomes.htm

  1. This guidance summarizes practices that should be considered when SARS-CoV-2 and Influenza viruses are found to be co-circulating based upon local public health surveillance data and testing at local healthcare facilities. While these considerations are specific to care of residents residing in nursing homes, some practices could be adapted for use in other long-term care settings (e.g. assisted living facilities).

 

The following COVID Healthcare IPC guidance has been updated:

  1. Guidance for SARS-CoV-2 Point-of-Care Testing
    1. This update includes minor revisions to the FAQ section.