Category: Infection Control & Prevention

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.

NIOSH’s Second EHMR Federal Register Notice Webinar

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Wednesday, November 18, 2020 1:00 PM EDT – 2:00 PM EDT
NIOSH’s Second Elastomeric Half-Mask Respirator (EHMR) Federal Register Notice Webinar

Elastomeric half mask respirators (EHMRs) are reusable respirators that may be worn in a healthcare setting and supplement the supply of disposable respirators available to healthcare workers. The National Institute for Occupational Safety and Health (NIOSH)-in coordination with the Strategic National Stockpile-posted a Federal Register Notice (FRN) titled “A National Elastomeric Half Mask Respirator (EHMR) Strategy for Use in Healthcare Settings During an Infectious Disease Outbreak/Pandemic”.

Through this FRN, NIOSH is seeking input regarding the national distribution plan of purchased EHMRs, as well as identifying potential organizations interested in receiving a portion of these EHMRs with the commitment to provide a report of user acceptability and feasibility of implementation.

NIOSH is seeking organizations including, but not limited to:

  • Hospital systems, individual hospitals, and/or specific hospital units (i.e., emergency department, intensive care units)
  • Outpatient care settings (i.e., offices, clinics, home care, urgent care, rehab centers)
  • Long term care facilities
  • Dental practices
  • First responder organizations (i.e., police, fire, EMS)

To learn more about how your organization can participate in this effort, please join us for a webinar on November 18 from 1:00-2:00pm (ET). NIOSH will provide an overview of EHMRs, a summary of the FRN, expectations of potential participants, next steps, and answer any questions you may have. Registration for the webinar is here.

PPE Available for Licensed Long-Term Care Facilities

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The Department of Health and Senior Services has gowns, alcohol prep pads, surgical masks, and shoe covers that can be ordered by long term care facilities in bulk. Please follow the survey monkey link (https://www.surveymonkey.com/r/KPY7ZWW) to place your order. If you are part of a larger corporation, your management company may want to submit an order for your organization.

Questions can be sent to Marcia.Davis@health.mo.gov.

Please note: If you have an active outbreak and submitted an order last week- do not submit another order this week. Thank you.

N95 Info

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Fit Under Fire: Situational Strategies to Achieve the Best Respirator Fit During Crisis

To aid healthcare facilities experiencing shortages of N95 respirators due to high demand across the nation, CDC developed the Strategies for Optimizing the Supply of N95 Respirators in Healthcare Settings which provides options on how to optimize supplies of disposable N95 filtering facepiece respirators (commonly called “N95 respirators”) in healthcare settings when there is limited supply. Proper fit of N95s is critical to your infection control/respiratory protection program.

For more information, please visit https://blogs.cdc.gov/niosh-science-blog/2020/03/16/n95-preparedness/.

National Training Program to Strengthen Nursing Home Infection Control Practices Launched

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QSEP has two new courses available for Long-Term Care staff about COVID-19!

One course is geared towards front-line staff, and the other is geared towards management. The courses are:

  • Targeted COVID-19 Training for Frontline Nursing Home Staff
  • Targeted COVID-19 Training for Nursing Home Management

Please see more information about how the courses may be accessed at the following link: https://qsep.cms.gov/ProvidersAndOthers/COVID-Training-Instructions.aspx.

Battelle Demobilization

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Throughout the COVID-19 response, the Battelle CCDS system has been an important part of lengthening the life of N95 masks, safely. Missouri users will continue to have access to decontamination through Battelle for the foreseeable future, however, some changes are coming for those who use the Battelle CCDS site at the Jefferson City Armory. This site will be demobilized with a projected final closure date of September 12.

Battelle will directly correspond with all users of the CCDS and provide them shipping labels to another Battelle site in a surrounding state. The shipping of masks will be at no cost. Due to increased shipping time, there may be some delays noted – so please plan accordingly.

If your facility is signed up as a Battelle user, you will receive direct correspondence from Battelle in the next 7-10 days. Until told otherwise by Battelle, you may continue to send your masks to the Jefferson City Armory.

Immunization Webinar Series – FREE!

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Starting August 20, 2020: Immunization Webinar Series

The purpose of this series of 5 webinars is to update the knowledge base regarding immunization practices and vaccine recommendations based on national guidelines and the latest evidence to guide practice.

Topics:

  • VFC 411 Immunization Scheduling
  • VFC 411 The Basics
  • Influenza Vaccination
  • COVID-19 Vaccine
  • Vaccine Hesitancy

More Information: https://extension2.missouri.edu/immunization-webinar-series-2-fy21.

HAI-Infection Prevention on the Frontlines: Back to the Basics – in the Midst of a Global Pandemic

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July 27 – September 6, 2020: ON DEMAND

Frontline nurses care for patients of all ages, across multiple care settings, with myriad health issues – not just those with infectious disease processes. It is a challenge to stay current with the latest evidence-based knowledge regarding infection prevention and COVID-19 has made this even more demanding. And depending on the practice setting, frontline nurses may have vastly different levels of institutional support and available resources to meet this demand.

The purpose of this conference is to enhance the capacity of frontline nurses to provide exemplary care to individuals with infectious diseases by focusing on the basics – which are applicable to all patients and always changing – and to demonstrate the profound impact an individual caregiver who practices from a proven base of evidence can have on patient outcomes. Linkages to COVID-19 are integrated throughout.

More Information including registration can be found at https://extension2.missouri.edu/hai-infection-prevention-on-the-frontlines-back-to-the-basics-in-the-midst-of-a-global-pandemic.

Summary Strategies to Optimize the Supply of PPE during Shortages

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CDC developed a quick reference table summarizes CDC’s strategies to optimize personal protective equipment (PPE) supplies in healthcare settings and provides links to CDC’s full guidance documents on optimizing supplies. These strategies offer a continuum of options using the framework of surge capacity when PPE supplies are stressed, running low, or absent.

https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/strategies-optimize-ppe-shortages.html

Be Infection Control Survey Ready: Join the Health Quality Innovation Network’s Office Hours Series

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The Health Quality Innovation Network (HQIN), the Quality Improvement Organization (QIO) for Missouri, is hosting an office hours series to support survey readiness and help nursing homes be responsive to identified opportunities, survey deficiencies and CMS enhanced enforcement actions. Each 30-minute session will demonstrate how to apply quality improvement principles to your infection control and prevention program and provide turnkey resources and tools to address gaps and drive improvement in your facility. A panel of nurses, infection preventionists and quality improvement professionals also will be available to answer questions.

The series begins July 14, 2020 and will cover the following topics:

July 14, 2020: Root Cause Analysis (RCA)
Facilities have worked hard to assess their infection control programs. But do you know the reason for the gaps or breakdowns in your program? We will share the HQIN QAPI RCA resource, which compliments the CMS QAPI RCA Guide.

July 28, 2020: Infection Prevention Action Plans
Once you complete the RCA process, then you must develop a plan of action. We will share the HQIN Infection Prevention Action Plan Templates. These templates compliment the CDC Infection Control Assessment tool. We will provide you with a template for key categories of improvement, i.e., hand hygiene, surveillance, environmental hygiene, etc.

August 11, 2020: Data Collection and Analysis
Once your plan is implemented, how do you know if it’s working? HQIN will share data collection tools to help you track and trend your improvement related to hand hygiene, terminal cleaning and PPE.

August 25, 2020: QAPI: Everyone Has a Role and a Responsibility
It takes a team to ensure improvement is made and sustained. HQIN will discuss how to engage your team in the quality improvement process in order to hardwire systems, change behavior, reduce gaps and to improve care and compliance.

Click here to register for one or all of these sessions. To learn more about HQIN, visit www.hqin.org.

Missouri PPE Manufacturers

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Below is a list of Missouri companies that are producing PPE, including what type of PPE (face shields, hand sanitizer, gowns, surgical masks) and their contact information.  Please feel free to reach out to these companies to see if you can develop a new supplier relationship.  Additional companies will be added as more companies acquire the capabilities to produce PPE.  The state will be providing some grant support to manufacturers so that additional types of PPE can be manufactured in Missouri, like N-95 masks and gloves.

Missouri Companies that Retooled to make PPE – June 25 2020