COVID-19 UPDATE #170
July 14, 2021
GUIDANCE FROM WASHINGTON STATE REGARDING AEROSOL GENERATING PROCEDURES IN ASSISTED LIVING AND SKILLED NURSING FACILITIES
Last month, WHCA notified facilities of proposed Washington State Labor and Industry (L&I) and Department of Health (DOH) guidance related to aerosol generating procedures (AGPs), staff use of respirators and resident room closure following the AGP procedures. See previous article published WHCA COVID-19 Update #162 | June 8, 2021.

On July 7, 2021, the Department of Health and L&I released updated guidance titled L&I and DOH Respirator and PPE Guidance for Long-Term Care: Employer responsibilities for respiratory protection program and provision of personal protective equipment (PPE). Please read the entire guidance regarding respiratory protection plans, the use of eye protection, and other PPE.

Of particular concern is the official release of the guidance regarding AGPs. The guidance states that long term care facilities, including but not limited to skilled nursing and assisted living facilities, must provide fit-tested respirators (N95, elastomeric or PAPR) to all staff with the potential to have contact with residents known or suspected of having COVID-19:
  • Providing care that requires getting closer than six feet to residents with known OR suspected COVID-19, including residents with one or more symptoms of COVID-19 who have not yet been tested or are awaiting test results.
  • Providing care that requires being in the same rooms as ANY resident who is receiving a procedure or undergoing an activity for which respirators are required due to the generation of aerosols that pose a COVID-19 transmission hazard.
  • This includes, but is not limited to, procedures identified by DOH, CDC, and the following: administering medicines with a nebulizer, spirometry, use of a BiPAP or C-PAP, deep or forced breathing exercises, or collecting or handling specimens from known or suspected COVID-19 patients. The door to the resident room should be closed during the procedure and for at least 3 hours following the procedure.
  • Anyone entering the room within 3 hours following the procedure must wear a respirator. If a facility knows the ventilation and filtration rate of the room, it may use this table from CDC to determine the time a room should stay closed following the procedure. If the door needs to remain open, workers walking by the open door must remain at least 6 feet from the open door, unless wearing a respirator.

As a result of this guidance, on July 13, WHCA met with representatives from the Governor’s Office, L&I, and other interested stakeholders to voice significant concern related to the feasibility of the adoption of this guidance for all residents regardless of COVID or suspected COVID status receiving AGP. As a result of this pushback, L&I has agreed to review and discuss this guidance with DOH for proposed changes and allowances related to resident vaccination status. WHCA will continue to meet with government representatives to press this issue and keep you informed of any changes. If you have questions, please contact Vicki McNealley or Elena Madrid.
LTC Q&A CALL SERIES REQUIRES NEW REGISTRATION
The weekly Department of Health (DOH) long term care call series has been scheduled for July 15 through August. If you have not registered for this new series, you may do so here. Because DOH needed to upgrade call capacity, a new registration is required. Once registered, you will receive an email containing information for joining the weekly call.
DEAR ADMINISTRATOR LETTER INFORMS PROVIDERS OF DOH WEBSITE UPDATE
In a Dear Administrator Letter dated July 8, 2021, providers are informed that the Department of Health (DOH) has moved all COVID-19 healthcare infection prevention materials to one location on their website. The letter also provides information on free online respiratory medical evaluation and onsite (or mobile) respirator fit testing. The information can be found here. The letter also includes information on the use of NIOSH approved N95 respirators and highlights that are effective immediately:
  • Use only NIOSH approved N95 respirators when respiratory protection is needed
  • Healthcare workers may continue to wear non-NIOSH approved KN95 and other respirators as source control only.

Providers are encouraged to reach out to Katherine Ander if they have questions.
ADDITIONAL RESOURCES
WHCA continues to post resources and information as it becomes available on our website. If you have questions or need additional information, please call the WHCA office at (800) 562-6170.