New Release: Heat and Humidity can be a Dangerous Combination

(JEFFERSON CITY, MO) – The Missouri Department of Health and Senior Services (DHSS) urges Missourians of all ages to take precautions as heat and humidity rise to dangerous levels.

Heat-related illnesses often affect the very young, the elderly and the chronically ill, but summer temperatures can also take a toll on healthy young and middle-aged adults.

In 2021, 18 people died from heat exposure in Missouri, ranging in age from 35-105 years. Half of the deaths occurred among those between the ages of 35-64.

During prolonged periods of high temperatures, using air conditioning – either at home or by seeking shelter in a local cooling center – is the best preventive measure.

“Heat and humidity can place a lot of stress on the body,” said DHSS Acting Director Paula Nickelson. “Heat exhaustion can come on suddenly, with little warning, and lead to heatstroke which becomes a very dangerous situation.”

During excessive heat, Nickelson urges Missourians to check on friends and neighbors, especially those who are elderly and chronically ill. To report a senior citizen or an adult with disabilities who is in need of assistance due to the heat, call the state’s toll-free abuse and neglect hotline at 1-800-392-0210, or make a report online.

Medications can impair a body’s response to heat, making them more vulnerable to the heat.

There are a number of steps individuals can take to stay cool including:

  • Wear appropriate clothing – wear lightweight, light-colored, loose-fitting clothing.
  • Stay cool indoors – stay in air-conditioned places as much as possible. Find a local cooling center.
  • Stay hydrated – drink plenty of fluids regardless of your activity level, and do not wait to until you are thirsty. Avoid sugary and alcoholic beverages; these actually cause you to lose body fluids.
  • Schedule outdoor activities carefully – try to plan outdoor activity for morning or evening hours when the temperature is coolest.
  • Pace yourself – reduce exercise or physical activity during the hottest part of the day, and take frequent breaks in the shade or in an air-conditioned place.
  • Wear sunscreen – sunburn affects your body’s ability to cool down and can make you dehydrated.
  • Prepare your home – change air conditioner filters, cover windows that receive morning or afternoon sun with drapes or shades, and make sure you have portable fans if necessary.

Knowing the signs and symptoms of heat related illness and how treat them is also important. Signs of heat exhaustion may include muscle cramps; heavy sweating; cold, pale and clammy skin; dizziness; headache; nausea or vomiting; and fainting or passing out. If you think you or a loved one are experiencing heat exhaustion, you should stop physical activity move to a cool place – preferably air-conditioned, loosen clothing, and sip cool water. Seek medical attention immediately if you are throwing up, your symptoms get worse or symptoms last longer than one hour.

Signs of heat stroke may include high body temperature (103°F or higher); hot, red, dry or damp skin; fast, strong pulse; headache; dizziness; nausea; confusion; or loss of consciousness. If you think you or a loved one are experiencing heat stroke you should call 911 immediately. Heat stroke is a medical emergency. Move the person to a cool place – preferably air-conditioned. Help lower the person’s body temperature with cool cloths or a cool bath until medical personnel arrive. Do not give the person anything to drink.

For more information regarding heat-related illness and prevention, visit the websites of DHSS or the CDC.

 

Emergency Protocol for Facilities
The Emergency Protocol was developed in 2007 for communication between long-term care homes and the Section for Long-Term Care Regulation (SLCR), in the event a disaster occurs that results in a loss of a necessary service (electricity, water, gas, telephone, etc.). This protocol was established to streamline communication so that homes can focus on what is most important – the safety and well-being of the residents.

This protocol (Emergency Protocol Handout for Facilities) provides the cellular telephone number corresponding to the region in which your home is located if you experience a loss in a necessary service – for instance Air Conditioning – that has the potential to affect resident safety or well-being. You are encouraged to contact the regional office main office telephone number during normal business hours as survey staff carry the cell phone and may be conducting a survey or inspection during working hours and may not answer immediately.

Provider Feedback Survey

The Section for Long-Term Care Regulation is again seeking input from providers we serve. We are asking for your help in identifying areas in our Section where excellent customer service is provided and areas where we need to focus on improving our customer service experience. Please take a couple minutes to complete our 2022 Provider Feedback Survey by June 30, 2022 at https://www.surveymonkey.com/r/72PRNZY.

COVID-19 Testing Reimbursement and Supplies

COVID-19 TESTING REIMBURSEMENT ENDING JUNE 15, 2022:
The last day to submit COVID-19 testing invoices for reimbursement via the DSS invoice portal is June 15, 2022. After June 15, 2022, the portal will be closed and no other testing invoices will be accepted.

Additional Testing Resources:
Free Antigen Testing Supplies
The Missouri Department of Health and Senior Services (DHSS) continues to have an adequate supply of free ACON Flow Flex rapid antigen tests all Long Term Care Facilities may apply to receive. Full details regarding the product, CLIA requirements, standing physician orders, and the Rapid Antigen Test Kit Application can be found here: https://ltc.health.mo.gov/archives/15339.

2022 SLCR Annual Provider Meetings

We are currently in the planning phase to host in-person provider meetings in all regions this year and are considering the best topics to provide the most beneficial information. We would like to hear from you about what LTC related topics and info you believe would be helpful and educational!

Please take a moment to answer complete a short questionnaire by May 31, 2022 at https://www.surveymonkey.com/r/9287QZQ.

New Changes coming in May for the COVID-19 Module Surveillance Pathways and Weekly HCP & Resident COVID-19 Vaccination Module

There will be various revisions to the LTCF COVID-19 Module surveillance pathways and COVID-19 Vaccination Modules for residents and healthcare personnel in the upcoming NHSN May release. CDC will be conducting training webinars next month. Please attend a training session to learn how data entry forms will change and receive instructions for accurate reporting. Below are a few changes you will see starting next month in the COVID-19 Module surveillance pathways.

NHSN COVID-19 Module Surveillance Pathway Forms will be Revised
New Changes Coming in May!!

What are the main changes?

Simplifications

  1. REMOVAL of Supplies and PPE Pathway
    1. Users will no longer need to report data to this pathway
  2. The Resident Impact and Facility Capacity Pathway (RIFC) and the Staff and Personnel Impact Pathway will have several data elements removed:
    1. COVID-19 test type
    2. Vaccine manufacturer (RIFC only)
    3. COVID-19 re-infections
    4. Other respiratory illness
    5. Testing performed and time for receiving results

Possible Additions

  1. Expand vaccination status options for boosters.
  2. Include simplified PPE shortage question.

How should I prepare for the upcoming changes?

  • Review ALL E-mail communication from NHSN
  • Attend COVID-19 Module trainings
  • Review the TOIs to assist with reporting elements
  • Update your CSV files as applicable
  • Templates will be updated on the COVID-19 webpage in May

How can I learn more?
CDC will be conducting training webinars in May. More information on these webinars will be shared in the coming weeks, so stayed tuned!

If you have questions, please send an e-mail to NHSN@cdc.gov with ‘COVID-19 Surveillance Pathway Forms’ in the subject line. Below are the changes that will also take place in the COVID-19 Vaccination Module starting next month.

 

NHSN Weekly COVID-19 Vaccination Cumulative Summary Forms will be Revised
New Changes Coming in May!!

What are the main changes?

Simplifications

  1. COVID-19 vaccination data will no longer be reported by vaccine manufacturer for questions on primary vaccine series and additional/booster doses.
  2. Questions on vaccine supply will be removed.
  3. Completing monthly reporting plans for COVID-19 vaccination modules in the Long-Term Care Facility Component will no longer be required. Instead, upon saving or uploading data, users will agree to the following:
    1. The data reported are consistent with definitions outlined in NHSN surveillance protocols (including tables of instructions and frequently asked questions).
    2. The data will be sent to the Centers for Medicare and Medicaid Services (CMS) to fulfill CMS quality reporting requirements (when applicable).

Additions

  1. Adding a note at the top of form specifying that data can be submitted by completing the questions on the data collection form or by using the new event-level COVID-19 vaccination forms.
  2. Adding a question for facilities to report the cumulative number of individuals who are up to date with COVID-19 vaccination.
  3. Adding two fields to question #4 to report the cumulative number of individuals who received only one booster dose and two or more booster doses of COVID-19 vaccine (Note: For residents only)

How should I prepare?
Facilities should develop or update data tracking mechanisms to collect weekly COVID-19 vaccination data on residents and healthcare personnel for the additional questions.

Tip: Using the new event-level COVID-19 vaccination forms in NHSN’s Long-Term Care Facility Component can simplify the tracking and reporting of data on multiple booster doses and up to date status.

How can I learn more?
CDC will be conducting training webinars in May. More information on these webinars will be shared in the coming weeks, so stayed tuned so you can register for the sessions.

If you have questions, please send an e-mail to NHSN@cdc.gov with ‘COVID-19 Vaccination Data Reporting’ in the subject line.

Reporting of Positive COVID-19 Cases – Changes Effective Monday, April 18th

Effective April 18, 2022, the existing Electronic COVID-19 Case Reporting System (ECD-1) will be disabled. This system will be replaced by the Missouri Disease Reporting Online Portal (MODROP). MODROP can be accessed directly from https://modrop.health.mo.gov/ or by using the existing ECD-1 link at https://health.mo.gov/living/healthcondiseases/communicable/novel-coronavirus/case-reporting.php and selecting the MODROP button.

NOTE: The recommended browser for use of MODROP is Google Chrome. Other browsers may cause issues with MODROP.

Facilities will need to register for a MODROP account the first time they use the new portal. MODROP allows reporting of only COVID-19 cases. Reports of other reportable conditions may be faxed to 573-751-6417.

Facilities performing their own COVID-19 testing (antigen testing) must report positive results through one of the following portals:

  • MODROP
  • In bulk via HL7 or CSV file using the DHSS- Electronic Lab Reporting process
  • National Healthcare Safety Network (NHSN) or the Association of Public Health Laboratories (APHL) Informatics Messaging Services (AIMS) Platform.

Facilities using an external laboratory (PCR testing) must enter positive case information into MODROP.

We are excited for this change and elimination of duplicate reporting of positive cases! If you have any questions or encounter any issues utilizing MODROP or for questions about HL7 or CSV reporting, please reach out to the EpiTrax Help Desk via e-mail at epitrax@health.mo.gov. The EpiTrax Help Desk e-mail account is monitored from 8AM-5PM CST Monday-Friday.

Please see the FAQ and thank you for your efforts to provide complete and accurate COVID-19 data to public health.

CNA Renewals/Work Updates

Note: The requirement to renew the CNA certification every 24 months is not a new regulation; however, the process to renew has been updated and a fee has been added.

**Please see this link for information on how to renew.

When a CNA passes the final examination, the individual’s name is placed on the CNA active registry. For nurse aide certification to remain active, CNAs are required to submit documentation (e.g., pay stubs, W-2, letter from employer, etc.) of their work in nursing or nursing related services for at least one (1) day (e.g. eight (8) hours) within each twenty-four- (24-) consecutive month time-period. Documentation shall be submitted to the department approved third party test administrator and a fee will be assessed for each renewal.

  • If you are a CNA needing to renew your certification and work in a facility: Log into your profile in TMU and enter your employment under the employment tab, upload your documents for proof of 8 hours of work and then pay the required fee. After the fee is processed, you will show active on the registry.
  • If you are a CNA needing to renew your certification with out of state employment: Log into your profile and select “out of state employment” and send an email from your employer with name, date of birth, employment dates and hours worked to missouri@hdmaster.com.
  • If you are CNA working private duty: Log into your profile in TMU and select private duty from a drop down menu. You will need to process the payment then email the proof of work documents to missouri@hdmaster.com. After work is confirmed, your certification will show active on the registry.
  • If you are a facility wanting to pay for multiple CNA’s renewal: You will need to fill out the form Employer Renewal Payment. If you have additional questions please email them at missouri@hdmaster.com or call at 800-393-8664 and ask for the Missouri team.

Health Update: Reporting COVID-19 Cases and SARS-CoV-2 Test Results

April 6, 2022: Update: Reporting COVID-19 Cases and SARS-CoV-2 Test Results

The Missouri Department of Health and Senior Services (DHSS) is issuing this Health Update to provide reporting laboratories and healthcare providers information regarding the changes in the reporting requirements for COVID-19 and SARS-CoV-2 test results in Missouri.

During the early stages of the pandemic response there were several changes to the reporting rules that were established through waivers during the State of Emergency issued by Governor Parson. The changes included the requirement that both negative and positive test results for COVID-19 were to be reported to DHSS within twenty-four hours. Additionally, reporters were required to only report directly to DHSS rather than having the option to report to either the Local Public Health Agency (LPHA) or DHSS. After the State of Emergency was lifted by Governor Parson, DHSS filed an emergency amendment to allow these requirements to continue. However, on April 1, 2022, DHSS terminated this emergency amendment and as a result, these requirements no longer exist. Please consider the following guidance regarding the reporting of COVID-19 and laboratory tests results for SARS-CoV-2.

Coronavirus Disease 2019 (COVID-19) remains an immediately reportable condition in Missouri. All positive laboratory results are required to continue to be reported to DHSS or the LPHA in accordance with rules established in 19 CSR 20.20.020. Healthcare providers, laboratories, and other mandated reporters should continue to report all COVID-19 positive test results including results from all Nucleic Acid Amplification Tests such as RT-PCR tests, and all rapid and antigen tests results for SARS-CoV-2. The reporting of positive home use tests is optional. However, DHSS will no longer require, or accept, negative laboratory results for SARS-CoV-2. In addition, DHSS is no longer requesting the routine reporting of positive or negative antibody tests results for SARS-CoV-2.

DHSS greatly appreciates the continued collaboration of our partners in healthcare and clinical laboratories. For questions regarding this Health Update and the reporting of COVID-19 in Missouri, please contact the DHSS Bureau of Communicable Disease Control and Prevention at 573-751-6113 or 800-392-0272 (24/7), or contact your local public health agency.

CMS Memo: QSO-22-15-NH & NLTC & LSC

Update to COVID-19 Emergency Declaration Blanket Waivers for Specific Providers

  • CMS continues to review the need for existing emergency blanket waivers issued in response to the Coronavirus Disease 2019 (COVID-19) Public Health Emergency (PHE).
  • Over the course of the COVID-19 PHE, skilled nursing facilities/nursing facilities (SNFs/NFs), inpatient hospices, intermediate care facilities for individuals with intellectual disabilities (ICF/IIDs), and end-stage renal disease (ESRD) facilities have developed policies or other practices that we believe mitigates the need for certain waivers.
  • Applicable waivers will remain in effect for hospitals and critical access hospitals (CAH).
  • CMS will end the specified waivers in two groups:
    • 60 days from issuance of this memorandum
    • 30 days from issuance of this memorandum

Please see the full memo at https://www.cms.gov/medicareprovider-enrollment-and-certificationsurveycertificationgeninfopolicy-and-memos-states-and/update-covid-19-emergency-declaration-blanket-waivers-specific-providers.

CNA Upcoming Testing

The following are updated CNA Testing sites.

Note: These are not the only test sites available. Please contact Headmaster D&S if you are need a different testing location.

Headmaster D & S: 1-800-393-8664 – Please ask for the Missouri Team!

All Regional dates are viewable on the online calendar at https://mo.tmutest.com/calendar.

To help with scheduling your testing event, contact Headmaster a few days after the CNA course starts.

Gladstone

      • March 24
      • April 7
      • April 17
      • April 21
      • April 28

St John/ St. Louis Area

      • April 9
      • April 12
      • April 23

Bolivar

      • March 23

Kirkwood

      • March 24

Kansas City

      • March 21
      • March 24
      • March 25
      • March 29
      • March 31
      • April 1

Trenton

      • April 13
      • May 14

Medicaid Resource (Spend-Down) Limit

The Medicaid Resource (Spend-Down) Limit has been increased to $5,035 as of 07/01/21. Please see the link https://dssmanuals.mo.gov/wp-content/uploads/2018/10/appendix_j.pdf.

F569 states the facility must notify each resident/legal guardian that receives Medicaid benefits when the amount in the resident’s account reaches $200 less than the SSI resource limit.

The current $200 amount would be at $4,835 or higher.

Feel free to contact Lynn Gilmore, Lead Auditor, at 573-508-4150 if you have any questions.

New Updates to the Headmaster Student Handbook and Mock Skills for CNA Testing

Please see the updated Headmaster Student Handbook and Mock Skills including key step changes for those students testing March 15, 2022 and after.

Please visit Headmaster’s website for those changes at https://hdmaster.com/testing/cnatesting/missouri/MO_CNA_Home.htm.

For questions regarding the changes, please call the Health Education Unit at 573-526-5686 or email us at CNARegistry@health.mo.gov. You may also call Headmaster and ask for the Missouri Team at 1-800-201-0462.

Governor Parson Announces Paula Nickelson to Lead Missouri Department of Health and Senior Services

During a press conference at the State Capitol, Governor Mike Parson announced that he has selected Paula Nickelson to serve as the Acting Director of the Missouri Department of Health and Senior Services (DHSS), effective March 1, 2022.

“Today, we are excited to announce Paula Nickelson as the new DHSS Acting Director,” Governor Parson said. “Paula was a key player in Missouri’s COVID-19 response efforts and has been a valued member at DHSS for more than 22 years. We are confident in her abilities and proud to welcome her to our Cabinet as we move forward from the COVID pandemic and prepare for what comes next in public health.”

Nickelson, a Missouri native, has served within DHSS for more than 22 years and has a distinguished career in public health and health care management. For most of her time with the Department, she has been a leader in several program areas, including maternal-child health, chronic disease prevention, and emergency preparedness and response.

Nickelson was also involved in the state’s H1N1 response and planning efforts following the 9/11 attacks. Most recently, she was instrumental in a number of COVID-19 response efforts.

Over the past two years, Nickelson has put her vast experience to work as a reliable, calming, and realistic leader to implement game-changing solutions during COVID-19. She helped establish the state’s first PPE warehouse, led an interagency team that implemented the “box it in” COVID mitigation strategy for long-term care facilities, oversaw the state’s antigen testing program, and led the implementation of the state’s decontamination system for N95 masks for health care workers when resources were still scarce.

Nickelson also developed strategies to establish state-funded monoclonal antibody infusion sites and was part of the team responsible for providing health care staffing support during two separate occasions.

“It is a great privilege to be asked to lead the Missouri Department of Health and Senior Services,” said DHSS Acting Director Paula Nickelson. “I am committed to enhancing our collaborative work with our local public health partners, our health care and behavioral health partners and all community partners. We will be focusing on the state’s leading causes of morbidity and mortality; prioritizing health equity; and ensuring updated data systems, performance management, and operational excellence tools are in place so we can serve Missourians in the best ways possible.”

Nickelson earned a Bachelor of Science in psychology from the University of Central Missouri and a Master of Education in counseling psychology at the University of Missouri-Columbia.

COVID-19 Reporting Changes

Effective 2/26/2022, facilities (RCF, ALF, SNF, ICF, and ICF-IID) no longer need to report the aggregate number of residents and staff tested during outbreak testing to the DHSS redcap portal. Below is a chart which outlines current reporting requirements.

 

Reporting Process/Form

System

Purpose/Description

Required?
For Whom?

Time Frame

1

Electronic COVID-19 Case Reporting

REDCap: DHSS

Reporting form for all positive case results, including staff and residents. This includes POC and PCR testing.**

Yes, for all SNF, ICF, RCF, ALF, ICF-IID and Adult Day Care

Within 24 hours of positive result

2

NHSN LTCF COVID-19 Module

Web Portal: Managed by NHSN

NHSN-required fields solely for certified nursing homes (SNF/NFs).

Yes, for all certified SNF/NF. Voluntary for any state licensed only facility (RCF/ALF/Adult Day Care) or ICF-IID.

Weekly, with a preference for submission on the same day each week

3

NHSN Point of Care Laboratory Reporting Tool

Web Portal: NHSN

POC test reporting that includes both positive and negative POC test results (even if potentially a false positive).

Yes, for any facility not reporting to DHSS in Row 4

Within 24 hours of result of POC test

4

Electronic COVID-19 Laboratory Reporting

Secure File Transfer/CSV file: DHSS

POC test reporting that includes both positive and negative POC test results (even if potentially a false positive).

Yes, for any facility not reporting to NHSN in Row 3

Within 24 hours of result of POC test

 

**Effective 2/25/2022, the Electronic COVID-19 Case Reporting System now requires entry of laboratory (testing) information when Positive Test for COVID-19 is selected as the Reason for Reporting. This change will allow for the data to more easily be ingested into Epitrax and readily available to Local Public Health Agencies- reducing follow-up contacts and calls to facilities to obtain the information.

 

CMP Applications for Portable Fans and Portable Room Air Cleaners

CMS has authorized the use of federal Civil Money Penalty (CMP) Reinvestment funds to purchase portable fans and portable room air cleaners with high-efficiency particulate air (HEPA, H-13 or – 14) filters to increase or improve air quality. A maximum use of $3,000 per facility including shipping costs may be requested. This opportunity is for facilities certified to participate in the Medicare and/or Medicaid programs. Since these are federal CMP funds, Residential Care and Assisted Living Facilities may not apply.

COVID-19_In-Person Visitation Application FAQ
COVID-19_In-Person Visitation Application Template

Please send completed applications to slcrcmp@health.mo.gov.

COMRU Upcoming Q & A Sessions

Please join COMRU (Central Office Medical Review unit) for a Q & A session via WebEx.

February 18, 2022
Time: 10:00 a.m.

Meeting number (access code): 2460 218 4769
Meeting password: MfVVW7asP23

Join from the meeting link: https://stateofmo.webex.com/stateofmo/j.php?MTID=m39c2a820985815deeedb03d8a797224d

Join from a video system or application: Dial 24602184769@stateofmo.webex.com

You can also dial 173.243.2.68 and enter your meeting number.

Tap to join from a mobile device (attendees only)
+1-650-479-3207,,24602184769## Call-in toll number (US/Canada)
+1-312-535-8110,,24602184769## United States Toll (Chicago)

Join by phone
1-650-479-3207 Call-in toll number (US/Canada)
+1-312-535-8110 United States Toll (Chicago)
Global call-in numbers

CNA Testing Events

Needing to schedule a CNA test? The following are dates and locations are already set. Please call Headmaster to register.

February 12, 2022: Cape Girardeau
February 14, 2022: Farmington (opens to public 48 hours prior)
February 17, 2022: Macon
February 19, 2022: St. Charles Community College (opens to public 48 hours prior)
February 22, 2022: Friendship Village, St. Louis
March 7, 2022: Nichols Career Center, Jefferson City
March 9, 2022: North Central College, Trenton
April 4, 2022: Nichols Career Center, Jefferson City
May 9, 2022: Nichols Career Center, Jefferson City

Other dates and locations may be available. Please call Headmaster at 1-800-393-8664 and ask for the Missouri Team.

State Antigen Testing Supply Portal Re-Opening Soon –

Please Read Information Below Carefully!

The Missouri Department of Health and Senior Services (DHSS) is pleased to announce that effective Thursday, February 10, 2022 at 8:00 a.m., we are reopening our antigen testing program! As you are aware, due to a nation-wide shortage of antigen tests and issues with receipt of tests from our distributor, it was necessary for us to suspend that program indefinitely in early January. For awareness, although Friday, February 11, 2022 is a state holiday, we will be accepting requests for tests, but no tests will be shipped on that day.

We have subsequently identified two distributors with adequate supply of ACON Flow Flex rapid antigen tests to allow us to reopen our antigen testing program. Information about ACON Flow Flex can be found here.

The transition to this different rapid antigen test requires the establishment of a new state-wide CLIA (although organizations with their own CLIA can continue to use their own) and thus verification of locations of testing and validation of training of all test administrators. Thus, it is not possible to simply transition existing BinaxNOW users to ordering for ACON Flow Flex – all existing users will need to re-apply to receive ACON Flow Flex, take the required training and provide verification of that training, resubmit a test plan inclusive of the infectious waste disposal plan, and provide the locations of testing in order to be approved to receive tests. Note: For organizations using their own CLIA, please be sure to add ACON Flow Flex to your CLIA waiver by contacting the state CLIA program (see additional information below).

New standing physician’s orders specific to ACON Flow Flex have been established for all tests users previously under a DHSS standing physician’s order. These new orders are available at: https://health.mo.gov/living/healthcondiseases/communicable/novel-coronavirus/testing-resources.php.

The DHSS Rapid Antigen Test Kit Application and Resource web page includes the initial application and a subject index to answer questions we received during the previous distribution of antigen tests. The page also provides information about where to direct specific questions that test users may encounter. If a test user is unsure of where to direct a question, please contact antigentesting@health.mo.gov.

The DHSS Rapid Antigen Test Kit Application and Resource Page for ACON Flow Flex will be open effective 8:00 a.m. on Thursday, February 10, 2022 at: https://health.mo.gov/living/healthcondiseases/communicable/novel-coronavirus/testing-resources.php.

Thank you for your continued work to fight COVID!

 

Adding ACON Flow Flex to Your CLIA Test Menu

The CLIA program has developed an email template that you can copy and paste, fill in the blanks, and email to CLIA@health.mo.gov to update your test menu to include ACON Flow Flex.

Email Subject line: Add COVID-19 Testing to existing CLIA Certificate for [FACILITY NAME]

Lab/Facility Name:  
Existing CLIA Waived Lab #:  
Lab Director Name:  
Which COVID-19/ SARS-CoV-2 Waived Test system added?
Check [X] all that may apply.

[    ] Abbott BinaxNOW COVID-19 Ag Card
[    ] Acon FlowFlex
[    ] Quidel Sofia 2 SARS-CoV-2 Antigen assay
[    ] Becton Dickinson Veritor™ Plus Antigen test kit
[    ] Abbott ID Now
[    ] OTHER Waived test(s) approved by FDA EUA (specify below):

As the Laboratory Director or administrator/owner’s agent of record for the CLIA facility holding a Waived Certificate identified above, I wish to append my facility’s existing CLIA# to include additional testing for COVID-19. I attest that my facility will provide reasonable assurances that:

  • All testing personnel for COVID-19 will be provided adequate and documented training
  • All Manufacturer’s Instructions for Use (IFU) will be strictly adhered to

All tests results (both positive and negative) will be reported to the proper public health entities under federal and state requirements. See MO DHSS link regarding reporting: https://health.mo.gov/living/healthcondiseases/communicable/novel-coronavirus/how-to-report-lab-results.php

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.

Life Support and Life Safety Code

There has been some confusion about the definition of “life support”, specifically related to the type of generator required. Life support refers to any function performed by equipment, which if stopped, could result in loss of human life or serious injuries. NFPA 99, 2012 edition: 3.3.42 defines Electrical Life Support Equipment as an electrically powered equipment whose continuous operation is necessary to maintain a patient’s life.

Life support is not limited to a ventilator. For example, it can be a BiPAP or suctioning machine. Facility staff should receive clarification from the physician prior to admission as to whether or not the equipment is necessary to maintain the resident’s life.

If a facility accepts a resident who requires life support, it is important to ensure all the following requirements are met per NFPA 99 and 110:

  • The facility must have a definition of life support;
  • The admission agreement must state the facility will accept a resident on life support;
  • The generator must comply with the standards of a Type 1 Essential Electrical System (ESS) (a Type 1 EES has the most stringent requirements for providing continuity of electrical service – the Acceptance Testing paperwork will show the type), complying with the National Fire Protection Association (NFPA);
  • Testing and maintenance must be maintained as outlined in the NFPA;
  • Depending on the generator, the power must be split into two or three branches, that would include critical care, life safety and mechanical;
  • There must be plans to show which rooms/areas are supported by the life support electrical system;
  • All outlets must be marked (such as a red outlet cover) to show which plugs will support life support functions.

NFPA 110, 2010 edition:

4.4-Level. This standard recognizes two levels of equipment installation, performance, and maintenance.

4.4.1-Level 1 systems shall be installed where failure of the equipment to perform could result in loss of human life or serious injuries.

4.4.2-Level 2 systems shall be installed where failure of the EPSS to perform is less critical to human life and safety.

4.4.3-All equipment shall be permanently installed.

K915

 Electrical Systems – Essential Electric System Categories

Critical care rooms (Category 1) in which electrical system failure is likely to cause major injury or death of patients, including all rooms where electric life support equipment is required, are served by a Type 1 EES.

CNA Upcoming Q & A Sessions

Please join the Health Education Unit and Headmaster D&S for a Q & A session via WebEx.

February 24, 2022
Time: 3:00 p.m.

Meeting number (access code): 2469 473 6547
Meeting password: XmZzZpGU333

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Join from a video system or application: Dial 24694736547@stateofmo.webex.com

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March 2, 2022
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**Winter Weather Planning**

Snow and ice are a mainstay of Missouri winter weather. Because of the variety of weather conditions as well as other events, facilities must have an emergency preparedness plan and be ready to act in an emergency to ensure they are to adequately prepared to meet the needs of patients, clients, residents, and participants during disasters and emergency situations.

If your facility experiences a loss of a necessary service (electricity, water, gas, phone, etc.), contact SLCR via the Regional Office emergency phone line and keep them informed of their status. If, for some reason, the facility cannot contact SLCR staff through the regional office phone number, you should contact the hotline. The emergency protocol is located here.

 When you call, be prepared to answer to the following:

 Facility name

    • Census, including staff assessment of current needs of the residents and monitoring of the ill.
    • Contact person and emergency contact number that is not the facility main line.
    • Has the facility called the fire department and central monitoring company if phones, alarm systems are down?
    • Generator: Y/N
      • If yes, what equipment does the generator serve (fire alarm, HVAC systems)?
      • If yes, amount of fuel onsite and/or system for delivery? How long will fuel last?
      • If no, what is fire watch plan?
      • If no, how will the facility ensure resident needs are met, including maintenance of room temperatures in a safe manner?
        • Obtain generator- is the home set up to receive generator power once delivered? Estimated time for delivery? Estimated time when generator power will be established.
        • Evacuation- Where is facility relocating to, distance from facility, transportation to get there, staffing, sufficient supplies/medications, how will the facility ensure resident needs are met, including maintenance of room temperatures in a safe manner (does the location have a functional emergency generator?) If relocating to a SNF – will the home be over capacity? Is there sufficient beds/space in the receiving facility to house the extra residents?
      • Documentation may be requested, including:
        • If evacuated, a list of residents and were they went
        • Room temperature logs
        • Fire watch documentation

 

Here are a few things to consider in examining your emergency preparedness plan, specifically as it relates to snow, ice, and power outages.

  • If there is a loss of the primary power, how will the facility ensure adequate temperatures of the facility will be maintained during the emergency situation?
  • Is the plan feasible?
    • Plan for the worst. Most events do not occur on a sunny Tuesday afternoon and the plan should account for things such as poor weather, road conditions, weekends/holidays, evenings, staff ability to travel to work, and other obstacles that may cause issue during the actual emergency.
  • Are staff knowledgeable of the plan and have access to what is needed in order to implement the plan?
    • Phone numbers, contact persons, contracts.
  • Do staff know what to do during an emergency and know who is in charge? If the administrator is not onsite, who is in charge and does that person know all their duties?
    • This may be the DON, but it may also be a charge nurse (or another designated onsite staff)if the event happens in the “middle of the night”. Depending on when the administrator or someone higher up on the order of succession can arrive at the facility, that person (i.e. night charge nurse) may be in charge for an extended amount of time.
  • Is the plan detailed enough?
    • Is there a detailed plan that describes when the residents will evacuate during an emergency? If loss of power, does the plan instruct the staff to start the evacuation prior to the point when the facility is below appropriate air temperatures and to maximize their safety during travel? What is the distance to the emergency evacuation site? What types of roads do they have to traverse, such as “side roads”, bridges, or interstates; all of these roads can have their challenges. Does the facility have more than one contracted emergency site?
      • Is it likely that emergency events will also impact the surrounding areas? It is also possible that the evacuation site may be so far away, residents may not be able to get there when road conditions are less than optimal. Does the contracted site meet all the criteria to allow the residents to shelter in place at that location?
    • Is there a contract for transportation and will that transportation be able to get the residents to and from their current location to the contracted emergency location in a snow/ice storm? If the services have other contracted uses, such as school buses, will they be available at 3:00 P.M. on a school day or can they get drivers at 3:00 A.M. on a Wednesday?
  • Does the facility have a generator?
    • Is there enough fuel, a contract to get more fuel, and a list of what it does and does not operate?
      • Facilities (and the staff in charge) need to know in advance, what their generator will operate. At a minimum, this listing must include whether it runs: Life safety equipment (such as E-lights and fire alarm system(s)), magnetic door locks/door alarms (where applicable for safety), HVAC systems, cooking systems, what outlets residents and staff will be able to be use, and computer equipment/Wi-Fi (if electronic medical records (EMR) are utilized).
      • This list needs to be detailed so staff will know specifically what items will and will not work during a power outage. Many generators will run every second or third ceiling light for emergency lighting, but not all lights in the facility will work during a power outage. This needs to be listed so all staff will know that information.
    • If a facility does not have a generator, what are the plans when it may not be easily able to evacuate due to poor road conditions or other factors that may prohibit a smooth transition from a facility to another location?
      • If the facility plans to have a generator delivered during a loss of power, does the facility have a contract with the generator company to deliver one to them? This contract should include the size of the generator that the facility will need in order to ensure the safety and care needs of the residents are met during the emergency.
        • The building will need to be wired and ready to accept the generator in advance. The facility will not be able to install a generator during the emergency event unless the wiring for the generator has already been completed.
      • Facilities must maintain at least their fire safety equipment (E-lights, fire alarm, sprinkler system, range hood (if any cooking occurs), food, water, heating and cooling, and sewage disposal to shelter in place.
        • There must be a plan of how this will be achieved, emergency supplies, the detailed list of what the generator will run, and any contracts that will be needed during the emergency to ensure these services can continue during the emergency event.
          • Sometimes trucks will not be able to run regular schedules and it may take several days before the facility can get their first delivery after an emergency starts; depending on the extent and severity of the disaster.
        • A power outage may be as simple as a blip, may last for hours, or may last for days – depending on the extent of the power grid damage and when the crews can access the problem(s).
          • The facility needs a plan of when, how, and where they will evacuate if they cannot provide at least the components of the previous bullet point.

During a disaster is the least ideal time to learn an emergency plan will not work or to search for a contracted service. All contracted services including, but not limited to, transportation, fuel needs, evacuation location, food, and water needs to be in the emergency plan. The emergency preparedness team needs to consider and plan all services and contract prior to an actual emergency. During an emergency, it may be very difficult or impossible to get a contracted service due to volume of request, road conditions, and/or other factors.

Thank you for preparing in advance and keeping us informed!

Guidance for the Interim Final Rule – Medicare and Medicaid Programs; Omnibus COVID-19 Health Care Staff Vaccination

https://www.cms.gov/medicareprovider-enrollment-and-certificationsurveycertificationgeninfopolicy-and-memos-states-and/guidance-interim-final-rule-medicare-and-medicaid-programs-omnibus-covid-19-health-care-staff-1

The guidance in this memorandum specifically applies to the following states: Alabama, Alaska, Arizona, Arkansas, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Mississippi, Missouri, Montana, Nebraska, New Hampshire, North Dakota, Ohio, Oklahoma, South Carolina, South Dakota, Utah, West Virginia and Wyoming.

Please read the memo in its entirety. Some key points in the memo:

Within 30 days after the issuance of the memorandum, if a facility demonstrates:

  • Policies and procedures are developed and implemented for ensuring all facility staff, regardless of clinical responsibility or resident contact are vaccinated for COVID-19, including all required components of the policies and procedures specified below (e.g., related to tracking staff vaccinations, documenting medical and religious exemptions, etc.); and
  • 100% of staff have received at least one dose of COVID-19 vaccine or have a pending request for, or have been granted a qualifying exemption, or are identified as having a temporary delay as recommended by the CDC, the facility is compliant under the rule.

Within 60 days after the issuance of the memorandum if a facility demonstrates:

  • Policies and procedures are developed and implemented for ensuring all facility staff, regardless of clinical responsibility or resident contact are vaccinated for COVID-19, including all required components of the policies and procedures specified below (e.g., related to tracking staff vaccinations, documenting medical and religious exemptions, etc.); and
  • 100% of staff have received the necessary doses to complete the vaccine series (i.e., one dose of a single-dose vaccine or all doses of a multiple vaccine series) or have been granted a qualifying exemption, or are identified as having a temporary delay as recommended by the CDC, the facility is compliant under the rule.

 Within 90 days and thereafter following issuance of the memorandum, facilities failing to maintain compliance with the 100% standard may be subject to enforcement action.