EPIC Newsletter
Emergency Preparedness Infection Control for Arizona's SNFs
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Happy National Skilled Nursing Care Week |
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Established in 1967 by AHCA, National Skilled Nursing Care Week (NSNCW) celebrates the essential role that skilled nursing care centers play in providing high quality 24-hour nursing care to millions of America’s seniors and individuals with disabilities. This year’s NSNCW theme—Cultivating Kindness—is inspired by the many acts of kindness that happen in skilled nursing care centers every day. Research has found that practicing compassion and kindness not only can improve health and well-being but can also strengthen human connections and bonds. Staff, residents, families, and members of the local community are encouraged to come together to participate in activities that cultivate and spread kindness during this special week, which began on Mother’s Day, May 14 and lasts through May 20, 2023.
Thank you for your dedication day in and day out to the residents of Arizona’s nursing homes!
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Infection Preventionist Call
The EPIC Infection Preventionist call is scheduled for Thursday, June 22 at 1:00.
Please email Kay Huff with any questions or to receive the Zoom link for the monthly calls.
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Free Technical Assistance Provided- Sign up now!
Clinical Infection Prevention and Control Consultation
Through the EPIC grant, Dr. Buffy Lloyd-Krejci and her team at IPCWELL are available to provide free consultative assistance with infection prevention and control programs for both skilled nursing facilities and assisted living centers. This will involve reviewing facility wide practices, offering supportive coaching, and evaluating infectious disease practices. To schedule a complementary visit contact meagan@ipcwell.
Industrial Hygiene Support
The EPIC program has also been awarded funding by ADHS to conduct free on-site, consultative services focused on infection control practices from a physical plant perspective at skilled nursing facilities and assisted living communities. Services are focused on water management, respiratory protection, Asbestos and mold consultation and indoor air quality. Please contact Stan Szpytek at Stan@azhca.org or (708) 707-6363 to sign up for these services and note that there is limited availability.
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Flu Vaccination Reporting Requirement Support
The NHSN Vaccination Unit has set up requirements for CMS-certified SNFs to report annual healthcare provider (HCP) influenza vaccination summary data through the NHSN Healthcare Personnel Safety (HPS) Component for the 2022-2023 influenza season. Reporting weekly influenza vaccination data through the NHSN Long-term Care Facility (LTCF) Component does not fulfill this reporting requirement.
The reporting period for the 2022-2023 influenza season is from October 1, 2022, through March 31, 2023. Facilities are required to submit one report covering the entire influenza season and the deadline to report the annual HCP influenza vaccination summary data through the NHSN HPS Component is May 15, 2023.
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AHCA NCAL, APIC Launch the National Infection Prevention Forum
AHCA NCAL is partnering with the Association for Professionals in Infection Control and Epidemiology (APIC) to launch the National Infection Prevention Forum (Forum), an online platform for all infection preventionists working in long term care. The Forum aims to help facilitate rapid dissemination of the latest updates regarding infectious diseases. Additionally, the Forum provides resources from the Centers for Disease Prevention and Control (CDC) and other federal agencies to help protect residents and staff.
Made possible through a Project Firstline grant from the CDC, the Forum is a collaborative space for infection preventionists to share best practices and participate in expert-led facilitated discussions. The Forum is housed on AHCA NCAL Connect, an online community platform which allows the creation of discussion threads among groups and the posting of resources and tools in an organized library. Infection preventionists interested in joining can do so for free. Once AHCA NCAL validates credentials, full access to the Forum will be granted. Learn more and register to join the National Infection Prevention Forum through the link below.
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HHS Will Continue Distribution of Tests After PHE Expires
The US HHS program that distributes Abbott BinaxNOW tests to SNFs and AL communities will continue after the end of the PHE, as they have not set an end date for it. HHS will be shifting the shipments of point-of-care (POC) Abbott Binax cards to Abbott Binax over-the-counter tests (OTC). These two products are nearly identical in use. The OTC tests will have at least 60 days until expiration at the time of delivery. The OTCs can be used as point-of-care in sites that have valid CLIA-waivers. Additionally, they can be self-administered by individuals who are capable.
As a reminder, facilities and communities must have an active CLIA waiver to receive shipments. Quantities received are based on CMS estimates of staffing and county positivity rates and allocation quantities. If there are questions related to the HHS BinaxNOW distribution Program, please contact Binax.team@hhs.gov.
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Survey Focus on Evacuation of
Non Compliant Residents
While the possibility of completely evacuating a skilled nursing facility is remote, providers must always be prepared to implement evacuation procedures for the entire facility. There is a real possibility that a few of the facility's residents may become frightened and refuse to evacuate during a real-world emergency. Staff must be trained and prepared to address a non-compliant resident(s) who refuses to evacuate.
Life Safety surveyors have been routinely questioning staff members to recite the procedures for handling a non-compliant resident refusing to evacuate. A sample policy and procedure is available on the Disaster Ready website in the "Respond" section labeled (Evacuation Support Information).
Once your facility implements this policy and procedure, all staff should be trained to demonstrate their knowledge of the procedure to surveyors but more importantly utilize the techniques cited to effectively evacuate a resident who refuses to evacuate during times of emergency.
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FDA Formally Authorizes Second Omicron COVID-19 Vaccine
The U.S. FDA has authorized a second dose of Omicron-targeting COVID-19 vaccines for older adults as well as those with a weak immune system. The agency also said the updated shots from Pfizer and Moderna would become the new primary COVID vaccine and withdrew its emergency-use authorization for the older messenger RNA vaccines that target only the original version of coronavirus. People aged 65 years and older can now receive a second dose of the updated "bivalent" booster four months after the first, while immunocompromised people can get an additional shot of the updated vaccine after two months, the agency said.
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Improving Skin Care and MDRO Prevention in LTC with the AHRQ Safety Program
Skilled nursing facilities are invited to participate in the Agency for Healthcare Research and Quality (AHRQ) program to reduce the spread of methicillin-resistant Staphylococcus aureus (MRSA) and other multi-drug resistant organisms. This is a free 18-month program that provides tips, tools, and resources.
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Prepare Now for Wildfire Season and Wildfire Smoke
The greenery that we see in the valleys, on the hills and up in the mountains means that we had a very wet winter. Well, that green won't last much longer as temperatures start to rise and humidity starts to drop. The lush landscape will turn to dead and dry vegetation which equates to a significant risk of wildland fires, even in the desert. Don't wait for things to dry out and the threat to become real. Now is the time to review your Emergency Operations Plan (EOP) as it relates to wildfires and other procedures including evacuation.
Even if you aren't directly impacted by a wildfire, your facility may be impacted by wildfire smoke. Below is a video produced by the DR/EPIC Team on wildfire smoke. Prepare your team now for the upcoming wildfire season.
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Emergency Plan Resources
During emergencies there are several concerns that need to be addressed early and continually assessed. While conducting Incident Command training, using check sheets is encouraged to help jog memories and provide a clear common operating picture to those inside and outside the facility. The Nursing Home Incident Command System (NHICS) forms such as Quick Start 200 and the NHICS 214 are helpful. When requesting assistance or guidance the agency at the receiving end of the communication will appreciate as much information as possible, obtaining information from the 200 and 214 forms and then including it in a standardized format. Receiving information in a consistent manner is likely to assist all parties with clear situational awareness on a local and countywide level. Helpful resources may include Maricopa County Public Health document and the Statewide County and Tribal Public Health Emergency Preparedness Coordinator's (PHEPs) contact list. Both documents should be included in your facility Emergency Operations Plan binder.
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CMS Regulatory Changes with the Ending of the COVID-19 PHE
CMS released the QSO-23-13-ALL notifying facilities that the 1135 emergency waivers terminated on May 11, 2023, with the end of the PHE. CMS also included that some of the regulatory requirements added during the PHE have also ended.
F885- Resident and Family Notifications
Which required facilities to notify all residents and their representatives about COVID-19 cases ended Monday, May 1, 2023, when above QSO was issued. Facilities are no longer required to notify all residents and their representatives when there is a positive COVID case in the facility, or if there have been three more residents with new onset of respiratory symptoms occurring within 72 hours of each other.
F888- Staff Vaccination Requirements
CMS will soon end the requirement for facilities to develop and implement policies and procedures to ensure that all staff are fully vaccinated for COVID-19. CMS stated that more detail regarding the end of this requirement will be available soon.
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CDC and CMS Updated Guidance for COVID-19
Now that the Public Health Emergency has ended both CMS and the CDC have updated their guidance for COVID-19. On of the Major changes is that the CDC will no longer publish the Community Transmission levels for COVID-19 and the CMS guidance is no longer based on these levels. To align with the new CDC guidance CMS has expired the QSO-20-38- NH and revised the QSO-20-39-NH. The major changes includes:
- Admission testing is now at the discretion of the facility. Testing for COVID-19 should be conducted by following accepted national standards, such as CDC recommendations. Non-compliance related to COVID-19 testing will be cited at F-tag 880, as F-tag 886 is no longer in effect.
- Source control is recommended:
- For individuals who have suspected or confirmed SARS-CoV-2 infection or other respiratory infection.
- For those individuals who had close contact (residents and visitors) or a higher-risk exposure (HCP) with someone with SARS-CoV-2 infection, for 10 days after their exposure.
- CDC includes broader use of source control as described in CDC’s Core IPC Practices in circumstances including outbreak, facility-wide or based on facility risk assessment and as recommended by public health authorities.
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Additional Guidance for the Expiration of the PHE
On May 1, 2023, the Center for Medicare and Medicaid Services (CMS) released an updated memo regarding the COVID-19 vaccine mandate and other items related to COVID-19. The memo summarizes that:
- CMS still expects facilities to conduct COVID-19 testing in accordance with accepted national standards, such as CDC recommends. Noncompliance with this expectation will be cited at F-880 for failure to implement an effective Infection Prevention and Control Program in accordance with accepted national standards.
- In QSO-20-31 All states are required to conduct FIC surveys in 20% of their nursing homes in fiscal year 2023. They are not required to conduct additional FIC surveys in fiscal year 2024 but may be completed at the discretion of the state.
- Reporting COVID-19 vaccine status of residents and staff through NHSN is permanent and will continue indefinitely unless additional regulatory action is taken.
- The requirement to inform the residents, their representatives and families following the occurrence of either a single confirmed infection of COVID-19 or three or more residents or staff with new onset of symptoms is set to terminate on December 31, 2024.
- CMS waived the requirement in 42 CFR 483.10(e)(5) and (7) solely for the purposes of grouping or cohorting residents with respiratory illness symptoms and/or residents with confirmed diagnosis of COVID-19 and separating them from residents who are asymptomatic or tested negative for COVID-19. This waiver of these requirements ends with the conclusion of the PHE (note that Section (e)(6) was terminated on 05/10/2021 per QSO-21-17).
View the entire updated guidance here.
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Check out our DR EPIC Helpline!
To submit questions, email the DR EPIC online helpline at EPIC@azhca.org. You can also call the DR EPIC phone Helpline at 602-241-4644 and we will assist you. or valuable infection prevention resources! Go to: EPIC.DisasterReadyaz.org to explore these tools.
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Questions? Contact EPIC@azhca.org |This program is funded by ADHS
The Disaster Ready Emergency Preparedness Infection Control (DR EPIC) program provides education and technical assistance for skilled nursing providers throughout the state. Individual providers will need to exercise their independent discretion in how to apply this information and technical assistance to the unique operation of each facility. For that reason, a facility’s of its professional judgment and due diligence in utilizing the program for infection control and risk management practices is solely within the facility’s control for which it is entirely responsible.
Copyright 2023.
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