Thursday, December 15, 2022 |
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EPIC Newsletter
Emergency Preparedness Infection Control for Arizona's SNFs
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Infection Preventionist Call Cancelled this Month
The EPIC Infection Preventionist call will be cancelled this month, due to the holiday.
Please email Kay Huff with any questions or to receive the zoom link for future monthly calls.
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PHE Extension Update
The Biden Administration has indicated it will renew the COVID-19 Public Health Emergency (PHE) currently set to expire on January 12, 2023. The Administration had committed to provide 60 days’ advance notice to the public prior to allowing the PHE to expire, and the 60 day mark passed last week with no public announcement. As such – it appears the Biden Administration intends to renew the COVID-19 Public Health Emergency in January.
Reminder of some of the policies tied to the PHE:
Medicare payment for telehealth – CMS has waived many of the typical restrictions on Medicare payment for telehealth during the COVID-19 emergency.
Medicaid “continuous enrollment” – In spring 2020, Congress provided an enhanced federal matching rate to Medicaid programs. As a condition of accepting this higher match, states were prohibited from dropping anyone from Medicaid coverage through the duration of the COVID-19 Public Health Emergency. In other words, AHCCCS won’t be doing redeterminations until the end of the PHE is in sight.
If US HHS extends the deadline for another 90 days, then it would potentially end in April 2023. If you have questions, please contact the AHCA office.
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Campaign to Increase COVID Boosters Announced
The Biden Administration announced a 6-week campaign to improve COVID-19 booster uptake rates. The campaign will focus on reaching seniors and other communities hardest hit by COVID-19, including a focus on nursing homes.
As part of this campaign, CMS is taking the following action:
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Verify compliance with QSO-21-19-NH which requires nursing homes to educate and offer the COVID-19 vaccine and subsequent boosters, particularly in facilities with low publicly reported vaccination rates.
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Encourage timely use of COVID-19 therapeutics through QSO-23-03-ALL. These treatments can prevent serious illness, hospitalizations and save the lives of high-risk individuals who would otherwise be at risk of severe complications even when vaccinated.
We strongly encourage you to do the following:
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If not accurate, check your NHSN reporting process and update your NHSN vaccination data for the next reporting period
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CDC is delivering a refresher training on NHSN reporting on Tuesday 11/29 at 1:30 ET
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Ensure you are meeting the requirements of QSO-21-19-NH and documenting all efforts to advise residents about the value of the booster for COVID.
- Contact your residents’ physician when they test positive for COVID-19 and develop any symptoms to ask them to start on antiviral or monoclonal antibody treatment. Do not wait until their symptoms progress.
Remember, COVID-19 boosters have been proven to be effective, along with antiviral treatments, in protecting individuals from serious illness, hospitalization and death. Staying up to date on COVID-19 vaccines is particularly important for nursing home residents due to their underlying health conditions that make them more susceptible to serious illness and hospitalization from COVID-19 and other respiratory viruses.
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CDC Guidance for COVID-19 Outbreak Nursing Homes
- Responding to a newly identified SARS-CoV-2-infected HCP or resident.
- When performing an outbreak response to a known case, facilities should always defer to the recommendations of the jurisdiction’s public health authority.
- A single new case of SARS-CoV-2 infection in any HCP or resident should be evaluated to determine if others in the facility could have been exposed.
- Perform testing for all residents and HCP identified as close contacts or on the affected unit(s) if using a broad-based approach, regardless of vaccination status.
- Testing is recommended immediately (but not earlier than 24 hours after the exposure) and, if negative, again 48 hours after the first negative test and, if negative, again 48 hours after the second negative test. This will typically be at day 1 (where day of exposure is day 0), day 3, and day 5.
- Due to challenges in interpreting the result, testing is generally not recommended for asymptomatic people who have recovered from SARS-CoV-2 infection in the prior 30 days. Testing should be considered for those who have recovered in the prior 31-90 days; however, an antigen test instead of a nucleic acid amplification test (NAAT) is recommended.
The guidance also includes that if additional cases are identified, strong consideration should be given to shifting to a broad-based approach and implementing quarantine for residents in affected areas of the facility. As part of the broad-based approach, testing should continue on affected unit(s) or facility-wide every 3-7 days until there are no new cases for 14 days.
If antigen testing is used, more frequent testing (every 3 days) should be considered.
Please contact AHCA’s Kay Huff for further questions.
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Reducing Respiratory Viral Infections this Winter
Respiratory viruses are more common during the winter months. Our elderly residents, particularly those with multiple medical conditions, are at risk for developing serious illnesses or exacerbations of their other illnesses, being hospitalized, or even dying.
Increases in Influenza, RSV, COVID-19, and other respiratory viruses are occurring in the general population, with some hospitals in communities nearing or at capacity. There are several key steps to help reduce the impact on residents from viral infections this winter.
- Get your flu shot and COVID-19 bivalent booster.
- Start antiviral treatment as soon as symptoms develop.
- Stay home if you are sick.
- Follow CDC guidance on infection control for respiratory viruses.
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Beware of “Tripledemic”
As fall fades into winter, please beware of the likelihood of a ‘tripledemic’: Covid-19, Respiratory Syncytial Virus (RSV) and influenza all at once.
AHCA NCAL’s Chief Medical Officer David Gifford "urged public health officials and policymakers to continue to prioritize long-term care residents to get boosted." Gifford said, "We are very concerned about these viruses impacting our long term care residents and staff this upcoming winter. We continue to strongly encourage our residents, staff, and the general public to stay up to date with their vaccinations to ensure everyone has the highest protection."
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Focus on Fire & Life Safety During the Holidays
It's easy to get caught up in the spirit of the season to promote goodwill and cheer in our long term care facilities. When creating Winter Wonderlands in your health care facilities and senior living communities, make sure that your team focuses on fire and life safety compliance so as not to create hazardous and non-compliant conditions. Always ensure that exits including hallways remain clear and unobstructed.
Don't hang items like garland, mistletoe or other holiday decorations from fire protection features like sprinkler heads and smoke detectors. Never allow "live" trees or other combustible decorations like "live" wreaths in your building as they represent a significant fire hazard and are prohibited by local, state and federal regulations in health care facilities as well as other public buildings.
If you still need proof that "live" decorations are a bad idea, watch this video produced by the National Fire Protection Association (NFPA) that clearly illustrates the hazards associated with a dry Christmas tree. Please don't consider this information as a "Bah Humbug" message but instead a friendly reminder to stay focused on safety during the holidays.
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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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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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Understanding NHICS and the Role of the Incident Commander
During a tabletop exercise in November, as the establishment of the command structure for the tabletop disaster exercise was being discussed, one of the participants who had conducted the evacuation of a SNF several years ago shared his perspective on the significance of the 'Incident Commander' (IC) role.
The IC not only determines what the objectives, strategies and tasks may be, she or he is also (intentionally or not), setting the tone for the rest of the staff to calmly yet deliberately carry out the necessary functions to have a successful outcome regardless of the emergency.
Whether the emergency calls for evacuation, shelter in place, power outage or pandemic response the IC sets the pace by:
- Communicating- by giving specific instructions and seeking feedback
- Delegating when necessary
- Supervises the scene
- Evaluates the effectiveness of the plan
- Understands and accepts the need to modify plans or instructions
- Ensures safe work practices
- Takes command of resources
- Motivates
- Demonstrates initiative by taking action
Please take a moment to review the Job Action Sheet for Incident Commander.
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AZ Bed Poll is a Resource
The Arizona Department of Health Services (AzDHS) recently conducted a joint, multi-state Significant Event Readiness Forum (SERF) with the Western Region Alliance Pediatric for Emergency Management (WRAP-EM) centered around an earthquake in southern California. The issues of treating and transporting people with access and functional needs (ADFN) was discussed at length. A segment of the Forum focused on transferring people in all healthcare facilities to other facilities that were not affected by the incident. A major task was identifying facilities that could properly care for those transferred. Accessing that information rapidly and real time is crucial to a successful outcome.
Arizona has a tool that can help identify locations as potential reception sites across the region/State EM Resource (AZ Bed Poll). This tool is only effective if data is entered in a consistent manor on a regular timeframe (daily). While there is no requirement to enter information in the database daily, it is a logical emergency preparedness practice to do so. Please take a moment to consider the benefits of utilizing these available tools.
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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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