Wednesday, November 16, 2022 |
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EPIC Newsletter
Emergency Preparedness Infection Control for Arizona's SNFs
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EPIC Grant Offers FREE Onsite IPC Support for SNFs in Arizona
The Emergency Preparedness and Infection Control (EPIC) grant administered by AHCA is offering onsite technical assistance in infection prevention and control. Dr. Buffy Lloyd-Krejci and her team at IPCWell are contracted to provide this support to skilled nursing facilities statewide in our 2022/23 grant.
They may assist with strengthening best practices, auditing IP protocols, reviewing policies, reporting, and addressing IP issues identified in the survey process.
They will provide a one-time onsite visit, FREE of charge, funded by the EPIC grant. If you would like to be on the list to receive this technical assistance, please contact Dr. Buffy at buffy@ipcwell.com.
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Infection Preventionist Call this Month
The EPIC Infection Preventionist call will occur on
November 17 at 1:00 pm.
Please email Kay Huff with any questions or to receive the zoom link.
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CMS and CDC Updated Testing and Visitation Guidance
Below are some of the revisions:
Testing:
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Routine testing of asymptomatic staff is no longer recommended but may be performed at the discretion of the facility.
- Testing is not necessary for asymptomatic individuals who have recovered from SARS-Cov-2 in the prior 30 days.
New admissions:
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Empiric use of Transmission-Based Precautions is generally not necessary for admissions or for residents who leave the facility for less than 24 hours.
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New/readmitted resident in areas where the community transmission levels are high should be tested upon admission. If they test negative, then test them again 48 hours after the first test and, if negative again, conduct a third test 48 hours after the second test.
- Residents who leave the facility for 24 hours or longer should generally be managed as an admission.
- New/readmitted resident and those who level the facility for 24 hours or longer should be advised to wear source control for the 10 days following admission/return.
Source control:
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When community transmission levels are high source control is recommended for HCP in areas they could encounter residents.
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When community transmission levels are high visitors should wear face coverings or masks.
- When the community transmission levels are not high source control is recommended for individuals who:
- Have suspected or confirmed respiratory infection.
- Had close contact with someone with COVID-19 for 10 days after contact.
- Reside or work in an area of the facility experiencing COVID-19 outbreak.
- Have otherwise had source control recommended by public health.
The new guidance no longer routinely recommends quarantine (for residents) or work restriction (for HCP) for asymptomatic individuals following COVID-19 exposures. However, if symptoms develop or the individual tests positive for COVID-19 then prompt isolation is required. For more information about the revised guidance please go to Infection Control: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) | CDC. Contact AHCA’s Kay Huff with further questions.
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CDC Releases Updates to COVID-19 Infection Prevention and Control Guidance
The CDC released updates to three guidance documents now available on its website. AHCA NCAL has provided a high-level summary of the changes (click here)and linked to each guidance for additional information.
You’ll note the major change is the source control requirements for those in low COVID-19 transmission areas. The agency notes that these updates have been made to reflect the high levels of vaccine- and infection-induced immunity and the availability of effective treatments and prevention tools.
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Reduce COVID-19 Hospitalizations with Paxlovid for Eligible Residents
As we head into the winter months, there will likely be an increase in the number of COVID-19 cases around the country. While vaccination continues to provide the best protection, COVID-19 therapies are widely available to help treat eligible people who do get sick and are at risk of developing severe disease. Antiviral treatments for patients at risk for COVID-19 reduces their risk of hospitalization and death.
The antiviral Paxlovid (ritonavir-boosted nirmatrelvir) along with Veklury (remdesivir) are they preferred treatments for eligible adult and pediatric patients with positive COVID-19 test results and who are at risk for progression to severe COVID-19. COVID-19 therapeutics should be considered for any COVID-19 patient who meets the eligibility criteria.
This information sheet summarizes current information about Paxlovid and offers resources about other COVID-19 therapeutics. In addition, a study was done to identify the efficacy of Paxlovid among elderly patients with co-morbidities.
The study identified that Paxlovid significantly reduced COVID-19 hospitalizations and deaths.
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It’s flu season again, which means it is time for facilities to offer residents the annual influenza vaccine unless medically contraindicated or they have already been immunized for the current season.
CMS requires facilities to offer the influenza vaccine from October 1 through March 31 annually; however, the CDC recommends offering the vaccine when it becomes available each season which also meets the CMS requirement. This requirement also includes that each resident is offered a pneumococcal immunization, unless the immunization is medically contraindicated, or the resident has already been immunized.
Prior to offering influenza and/or the pneumococcal vaccines, CMS requires facilities to develop policies and procedures to ensure that each resident or the resident’s representative receives education regarding the benefits and potential side effects of the influenza and pneumococcal immunizations prior to them being offered. The resident’s medical record should include documentation that the resident or resident’s representative was provided education regarding the benefits and potential side effects of the immunizations. The documentation should also include whether the resident received the immunization, or not due to medical contraindication or refusal.
The guidance to surveyors includes “Review facility policies regarding the provision of vaccines in order to determine if the policies reflect current standards of practice.”
For information related to current vaccine recommendations including scheduling and contraindications, refer to the frequently asked influenza questions button below. Contact AHCA’s Kay Huff with further questions.
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RSV Cases Surge
Cases of RSV (Respiratory Syncytial Virus) and Influenza have risen early in Maricopa County this year. Anyone can get sick with RSV however, young children and individuals with underlying lung disease are at greatest risk for severe disease.
The last two years in Maricopa County the flu case rates have been below the 5-year average. As of November 2, 2022, influenza cases are 10 times higher than the same time last year. The best way to prepare ourselves, our staff and our residents against influenza is to get vaccinated as soon as possible. The flu vaccine has shown to reduce deaths, intensive care unit admissions and length of hospitalization among hospitalized flu patients. Many of Maricopa’s community vaccination events are providing flu shots for anyone 6 months and older. Visit vaccines.gov/find-vaccines to find a flu and COVID-19 vaccine location near you. A friendly reminder… like COVID-19, one case of influenza in a facility is considered an outbreak.
If SARS-CoV-2 and Influenza viruses are found to be co-circulating within a health care facility the Center for Disease Control and Prevention (CDC) recommends testing for both viruses. For additional considerations and guidance regarding testing and an outbreak of Influenza see the links below.
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Life Safety Survey:
Water Management Plan
It is common for the Life Safety Survey team to review and assess your facility's water management plan during the regulatory survey process.
Providers must remember that a healthy and compliant environment of care does not happen by accident. It requires expertise and a level of proficiency in facilities management that will help ensure the health and safety of all occupants in a long term care community.
A number of resources are posted on the Disaster Ready EPIC website to help your facilities management team develop and sustain a reliable water management program to help protect all stakeholders at your facility. |
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Need a Tabletop Exercise? Disaster Ready Has You Covered
Skilled nursing facilities are required to complete at least two emergency preparedness exercises each year including a community-based, full scale exercise and an "exercise choice" in accordance with CMS regulations. The exercise of choice can be a tabletop exercise.
The Disaster Ready program has developed four tabletop exercises that can be used to conduct an exercise at your facility on your own schedule in a virtual format. Essentially, using these resources will be like having the Disaster Ready Team in the classroom facilitating the exercise through a well-produced video that will take participants through an emergency scenario that they must manage.
The tabletop exercises currently in the Disaster Ready Video Library include active shooter, cyber-attack, fire and flood. Some of these videos also address emergencies in behavioral care facilities as well as incidents occurring during a pandemic.
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CMS Releases Memos on Fire Safety Evaluation System and Revised COVID-19 Staff Vaccination Requirements
S&C: 17-15-LSC-Revised: Use of the Fire Safety Evaluation System
CMS finalized new mandatory values in August 2022 for the Fire Safety Evaluation System (FSES). CMS this last week released revisions to the FSES memo, which negate the need for a waiver and now allow SNFs to once again achieve a passing score on the FSES without any impact on the fire safety of the facility.
QSO-23-02-ALL: Revised Guidance for Staff Vaccination Requirements
On November 5, 2021, CMS published an interim final rule with comment period. This rule establishes requirements regarding COVID-19 vaccine immunization of staff among Medicare- and Medicaid-certified providers and suppliers. CMS this last week revised guidance for staff vaccination requirements (for all provider-types) related to assessing and maintaining compliance with the staff vaccination regulatory requirements. The memorandum replaces and consolidates information from previous memoranda QSO 22-07-ALL Revised, QSO 22-09-ALL Revised, and QSO 22-11-ALL Revised. The guidance applies to all states.
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Supply Chain Integrity
The issues surrounding the supply chain integrity were significant during and post COVID 19 and may still be with us to a lesser degree.
The Arizona Coalition for Health Care Emergency Response (AzCHER) collaborated with Arizona State University, to assess ways to mitigate, minimize the gaps in the health care supply chain.
The assessment is a detailed account of clear and significant vulnerabilities along with a wide range of mitigation strategies, the capabilities required to engage in mitigation activities and equally important, the required business structure needed to address supply chain integrity.
This assessment addresses the supply chain issues in all health care provider types. The intent of publishing this document is to educate those in the health care system who have the responsibility to maintain adequate resources for business continuity.
Please take the time to review the assessment to determine if there are pieces of it that might be helpful to your facility.
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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 2022.
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