In efforts to continue support of the nation’s COVID-19 response, the Centers for Disease Control and Prevention’s (CDC’s) National Healthcare Safety Network (NHSN) is excited to announce the following updates to the COVID-19 Module for Long-Term Care Facilities (LTCF):

1. An NHSN COVID-19 Module Dashboard for LTCFs is now available for participating groups and The dashboard provides a summary of data entered in the COVID-19 Module and includes an interactive chart display where a user may customize data views. This first edition of the dashboard is concentrated on the Resident Impact and Facility Capacity pathway. However, we’ve already started working on the next edition, which will continue additional pathways and analysis options!! Guidance documents for groups and facilities to assist with navigating and understanding the features are available on the NHSN LTCF COVID-19 Web-page.

2. You asked, and we listened! We recognize that many SNFs are setting up COVID-19 units to receive transfers from other LTCFs, such as Assisted Living Residences. These transfers result in increased demand on the receiving LTCFs. Therefore, the count for “Admissions” has been revised to include admissions and readmissions of residents who were previously diagnosed with COVID-19 from another facility. For additional information, please review the revised data collection form and accompanying instructions for the Resident Impact and Facility Capacity Note: LTCFs may update previously entered “Admissions” counts, but this is not a requirement.

3. We aim to improve the quality of the COVID-19 data being reported. Users will notice Pop-up alerts as a reminder of potential data entry errors. For example, if a user attempts to enter more COVID-19 Deaths than Total Deaths, a pop-up alert will appear to remind user of the definitions. As a reminder, “COVID-19 Deaths” counts must be included in the Total Deaths count since Total Deaths is defined as the number of residents who died for any reason in the LTCF or another location since the last time “Total Deaths” counts were collected for reporting in the NHSN COVID-19 Module. For both counts, only include the NEW deaths since the last time the counts were collected for reporting in the Module, as the intent is to capture incidence.

4. Non-modifiable fields have been added to each of the four pathway screens. Users will notice that each pathway now has three additional pieces of information displayed at the top of each pathway: Date Created, Facility CCN, and Facility Type.

The purpose of Date Created is to display the first date and time of data entry (manual or CSV file upload) for a selected calendar date and pathway. The date and time will automatically save and cannot be modified by the user.

The Facility CCN and Facility Type will also populate for each facility, allowing users to quickly verify the information associated with the data being submitted to CMS. These two variables may be edited by a facility user with NHSN Administrative rights; however, edits must be done outside of the COVID-19 Module by accessing Facility Info on the left navigation panel. Guidance documents are attached to this e-mail, as well as available under Facility Resources on the NHSN LTCF COVID-19 Web-page, which can be accessed through the following link – https://www.cdc.gov/nhsn/ltc/covid19/index.html (you may need to copy and paste web-link into Internet browser).

Be sure to check-out the July NHSN LTCF newsletter for additional information and exciting updates! If you have questions, please send them to nhsn@cdc.gov and include LTCF in the subject line.

Division of Community and Public Health (DCPH) recently reached out to the CDC for guidance regarding long-term care facility (LTCF) residents attending routine off-site appointments and received the following response:

CDC does not recommend LTCF residents who go off-site for routine appointments (such as hemodialysis or other routine appointments or treatments) be kept in observation, in part because the observation period could be permanent for residents who have to leave more than once every two weeks. Additionally, LTCF residents who leave and return for appointments should not be considered new admissions or be housed in a COVID-19 care unit in the LTCF when they return. Placing LTCF residents who return in the observation or COVID area within the facility could put them at higher risk of exposure to COVID-19. While not a CDC recommendation, some LTCFs have opted to manage residents who go off-site for routine appointments as potentially exposed and use full Transmission-Based Precautions and/or have cohorted these residents together into the same area of the building. In these examples, it is very important to ensure these residents, who may be at increased risk of acquiring COVID-19, are NOT being placed into a dedicated COVID-19 unit or with others who are symptomatic/have increased risk of having COVID-19. Doing so would increase the risk of exposing these residents who go off-site to others at even higher risk of COVID. We have also heard about significant challenges with moving residents repeatedly and recognize that determining exposures can be challenging. Additional recommendations: Residents going off-site for dialysis or other appointments should wear a cloth face covering (or facemask) for source control when they leave the LTCF and ideally in the LTCF if they are leaving their room. Regular communication between the dialysis facilities/medical offices where appointments occur and the LTCFs (in both directions) is essential to help identify patients with fever or symptoms consistent with COVID-19 before they enter the facilities and facilitate resident care. Social distancing measures should be implemented, such as minimizing movement of these residents within the facility as much as possible. LTCFs should comply with the infection prevention and control guidance for nursing homes and LTCFs.

The guidance has been updated to request facilities bill Medicare first, if applicable, for testing costs and to provide contact information when submitting invoices. In addition, for SNFs only, updates have been made to the attestation form and information regarding costs being capped per facility.

Please see Updated LTC Guidance Invoicing Process (06222020) for additional information.

Since Feb. 3, Missouri hospitals have been reporting daily data to establish situational awareness of hospital capacity while preparing for and responding to the spring outbreak of the SARS-CoV-2 virus. Using these data, the Missouri Hospital Association has distributed a daily statewide dashboard of the current impact and capacity of COVID-19 in Missouri hospitals. A copy of today’s dashboard is included.

Information from the daily dashboard has supported local, state and federal officials in gaining day-to-day awareness of Missouri’s hospital capacity. The reports also have been used by the media to keep the public updated on hospital response.

Throughout the spring, more data that offer additional detail and trends have become available. To keep the report current, it has been modified several times to capture these new data elements. However, as we move from our initial response to the surge to our current status of recovery, it is critical we look at data trends in different ways to help us better understand the impact of the pandemic on our state and individual communities, and detect possible future trends. Today, MHA and the Hospital Industry Data Institute are pleased to introduce new, weekly COVID-19 dashboards providing regional trends and models of predicted cases. Concurrently, the aforementioned daily, situational awareness dashboard will be phased out. Daily situational awareness will remain available on the Missouri Department of Health and Senior Services’ website.

These regional dashboards have been developed in partnership with Missouri state agencies, hospital leaders and researchers at the Institute for Public Health at Washington University, and are included below for your review.

• Kansas City Region
• St. Louis Region
• Northeast Region
• Northwest Region
• Central Region
• Southeast Region
• Southwest Region

The new dashboards were designed with the intent to serve a larger audience. As Gov. Parson continues to lead the Show Me Strong Recovery plan, government officials at all levels, along with local businesses, schools, churches and other organizations, will need access to innovative monitoring tools to help manage their reopening efforts. These dashboards – with state and regional focus, along with the element of predictive understanding – will serve as a tool to help you and the leaders in your organization have better awareness of the pandemic. Further, the regional dashboards will complement other information currently used for COVID-19 planning and decision-making.

Correction to the link to order testing supplies from the state public health laboratory: The below message has been updated to reflect a change in the link to order testing supplies from the state public health laboratory.

Facility-wide testing for all residents and staff is included in the most recent DHSS guidance (https://health.mo.gov/living/healthcondiseases/communicable/novel-coronavirus/ltcf.php) for communities that have a positive COVID-19 case. We are encouraging all communities to be prepared for this possibility so that should this occur, there will be no delay in testing implementation.

There are several coordination points that are necessary in order to have a successful testing plan. This includes having access to testing kits (both swabs and media – must have both), the ability to collect the specimens onsite, and establishing an agreement with a lab to process the specimens. To assist in this preparation, testing kits may be ordered through the state public health laboratory at https://health.mo.gov/lab/index.php or https://health.mo.gov/living/healthcondiseases/communicable/novel-coronavirus/specimen-collection-supplies.php. The state public health laboratory recently received testing combination kits that contain both the swabs and media. These kits are listed as “Swab/Media Combo – Remel MicroTest M4RT Transport 3ml vial with Nasopharyngeal swab” and are available for any long-term care community. We encourage all to take advantage of this current testing kit supply and to order enough supply to complete two rounds of facility-wide testing. The test kits do not expire until April 2021, so they are acceptable for use for several months.

**UPDATE – The specific kits referenced above are now out of stock. There are other testing supplies available to any long-term care community. Please ensure when ordering testing supplies, both swabs and media are needed for a complete testing kit. Please do not order every item on the list of supplies and keep in mind the number of testing kits needed for your community.

Long Term Care facilities, including Assisted Living facilities, Residential Care facilities, Intermediate Care facilities, and Skilled Nursing Facilities (LTCs) that experience an outbreak (one or more positive case) of COVID-19 are working with the state to conduct base-line facility testing and some immediate follow-up testing in order to contain the outbreaks. In order to furnish immediate aid and relief in response to the state of emergency due to the spread of COVID-19, the state is making some funds from the Coronavirus Relief Fund available to LTCs, so that cost is not a barrier to this important testing. Questions regarding this process should be submitted to COVID19invoice@dss.mo.gov.

LTC Guidance Invoicing Process

The Department of Health and Senior Services posted a State of Missouri COVID-19 analytics update on June 3. The link is here: https://health.mo.gov/living/healthcondiseases/communicable/novel-coronavirus/pdf/analytics-update060320.pdf.

This analytics updated includes multiple data points inform Missouri’s COVID-19 response. Check the update to find out more about:

• Syndromic surveillance
• Healthcare system capacity (bed, PPE, and staff availability)
• Testing
• COVID-19 cases and deaths
• Economic and social impact
• Insights from U.S. states, nationally, and other countries
• Evidence from scientific literature
• Mathematical disease modelling