A. Facility will update authorized family members and guardians of infected residents at least once per day and upon a change in a resident’s condition and at least once a week via robo call / memo notification to update all residents and authorized families and guardians on the number of infections and deaths at the facility.
B. Recreation will help facilitate communication via facetime or telephone for residents, families and guardians who wish to communicate with their loved ones at no cost.
A. Upon admission/ readmission all residents will be swabbed for covid, and placed on isolation in a single room or an empty semiprivate room and monitored until determination of test result.
B. Residents that have a confirmed case of COVID –19 can cohort with other residents who have a confirmed COVID-19 on Covid wing.
C. Residents with suspected or confirmed COVID –19 will have a plastic cover on the front entry of their rooms, and have the signage on the door indicating Droplet and Contact precautions with designated PPE Inside and outside the rooms.
D. All efforts will be made to have consistent caregivers assigned to residents with suspected or confirmed COVID – 19. These staff members will not float to other units.
E. Upon receipts of negative swab resident will be monitored for an additional three days for signs and symptoms. Post three days of no signs and symptoms resident will transfer to negative Covid unit/section.
F. In accordance with facility policy, all applicable laws and regulations. Facility will preserve a bed for residents who are hospitalized.
A. The Facility has a 60 day stock pile of N95, gloves, face shields, gowns and surgical masks. We have adequate supply of hand sanitizer, hand soap and disinfectants. We will continue to order additional items through contracted vendors to build up inventory. The stock pile of Personal Protective Equipment at the facility is being monitored through an inventory system. When items become depleted, more will be ordered. It is essential that inventory stays up-to-date so that items can be ordered in a timely manner. We realize that the current demand for PPE is higher (and could stay that way for quite some time), therefore, we will need to take into account the length of time it may take to receive the ordered items. We hope to continue to use the same vendors that we had originally ordered from, but we do have a backup in place.
A. The facility will cohort residents with no COVID symptoms, unknown COVID-19 virus, and confirmed COVID-19 virus. Newly admitted Residents with unknown COVID status will tested upon admission placed on the Isolation Unit pending their results.
B. All New and Readmissions will have a review of hospital information prior to readmission to determine if infection prevention and treatment needs can be met at the facility.
C. New admissions and re-admissions with a Dx COVID-19 will be reviewed to determine if they are still considered to be infective with the COVID-19 virus. The following is required for placement on a Negative COVID unit:
a) Results of 2 negative COVID-19 test results done at least 24 hours apart.
b) Documentation in medical record that resident has met the Non-Test criteria for the discontinuation of transmission-based precautions.
D. All residents will continue to be assessed daily for any symptoms of COVID 19 including fever, respiratory symptoms or any change in condition will be done daily and as needed.
E. Any resident presenting with signs or symptoms of COVID 19 infection will be assessed by PMD/NP. In addition, any new case developed in the facility without hospitalization will be investigated by Infection Preventionist to determine source through contact tracing. See CDC at: https://www.cdc.gov/coronavirus/2019-ncov/php/principles-contact-tracing.html.
F. Identification, early work-up including testing as indicated and treatment will be initiated by clinical staff for all residents with suspected or confirmed COVID 19
G. The facility will continue to promote consistent assignment staffing as below:
· The staffing coordinator in conjunction with the DON/RNs will make every effort to have Residents that have confirmed COVID to be grouped into one assignment.
· Every effort will be made to have residents that have suspected COVID to be grouped into one assignment
· Every effort will be made to have residents that have NO symptoms of COVID or who have had transmission-based precautions discontinued to be grouped into one assignment
H. Residents who are confirmed or suspected of COVID-19 will have the signage on the door indicating Droplet and Contact precautions with designated PPE and ABHS readily available inside and outside room.
1. All Residents on these units have no symptoms of COVID, or have had transmission-based precautions discontinued based on either the testing or non-testing strategy.
2. Caregivers will be required to wear a face mask and follow standard precautions on these units/wings.
3. If any resident on one of these units becomes symptomatic or suspect for COVID, he/she will be transferred to the Isolation unit and a Physician/NP will assess and order COVID-19 testing and any treatment as indicated.
4. Residents on these units will continue to be monitored daily for temperature, and any other symptoms that could be suspect for COVID-19.
1. Residents admitted or re-admitted from the hospital with unknown COVID status will be tested and placed in this designated area on Contact and Droplet Transmission based precautions to ensure that they are not carrying the COVID virus.
2. Transmission Based Signage for Droplet and Contact precautions will be posted on the doors of all residents.
3. All residents in this area will require Contact and Droplet Precautions. Caregivers will wear full PPE to include gown, face shields, masks and gloves
4. Residents in this area will continue to be monitored daily for signs and symptoms of COVID related illness including TPR and pulse oxygen levels.
5. Residents whose tests result in positive will be transferred to the COVID CONFIRMED unit.
6. Residents whose test result in negative will be transferred to a COVID Negative unit.
7. Residents on these units will continue to be monitored daily for signs and symptoms of COVID related illness temperature screening.
1. Residents on this units will have confirmed cases of COVID-19 and Symptoms consistent with COVID-19
2. Residents testing positive for COVID -19 will be roomed in one area of the unit.
3. Residents identified with COVID 19 symptoms will be identified as Person Under investigation (PUI) and will be cohorted with a COVID 19 PUI resident in 1 of 2 designated room on the unit. Residents will be encouraged to wear a mask if tolerated and educated in respiratory etiquette. Cubicle curtains can be used as indicated.
4. Residents identified as PUI will be tested and treatment and labs will be ordered as needed.
5. PUI residents whose tests result in positive will be transferred to the COVID CONFIRMED area.
6. PUI residents whose test result in negative will be transferred to a COVID Negative unit.
7. Transmission Based Signage for Droplet and Contact precautions will be posted on the doors of differentiating those who are confirmed with COVID-19 and those who are PUI
8. All residents on this floor will require Contact and Droplet Precautions. Caregivers will wear full PPE to include gown, face shields, masks and gloves.
9. Residents on these units will continue to be monitored each shift for symptoms and clinical signs indicating a worsening of condition.
10. Residents will be offered and encouraged to wear a face mask.
11. Residents that pass the 14-day mark and no longer require droplet and standard precautions will be evaluated by MD/NP to determine if they can be moved to a COVID negative unit based on the non-testing strategy.
(SEE: PPE PROTOCOLS FOR ISOLATION UNIT)
1. Hand hygiene after each resident encounter by all staff in all departments.
2. Proper use of gloves with glove changing between all residents and hand hygiene performed before donning new gloves.
3. Universal masking on all units will continue for all staff in all departments. Avoid touching eyes, nose and mouth with hands.
4. Identify and Report immediately any change in Resident condition to Charge Nurse and/or RNs.
5. Do not come to work if you are ill. Contact RNs if you become ill while working.
6. If you have a question or need support please ask, All Team members are valued.
Please Note: To Ensure Residents rights are upheld any room transfers will be discussed with resident/resident representatives and orientation to new room and roommate will be conducted by SW/Designee. All room transfers will be documented in accordance with state and federal regulations
5. Communicable Disease Reporting:
– NYSDOH is charged with the responsibility of protecting public health and ensuring the safety of health care facilities.
– Reporting is required to detect intra-facility outbreaks, geographic trends, and identify emerging infectious diseases.
– The collection of outbreak data enables the NYSDOH to inform health care facilities of potential risks and preventive actions.
– Reporting facilities can obtain consultation, laboratory support and on-site assistance in outbreak investigations, as needed.
NYSDOH Regulated Article 28 nursing homes:
a. Reporting of suspected or confirmed communicable diseases is mandated under the New York State Sanitary Code (10 NYCRR 2.10), as well as by 10 NYCRR 415.19.8
b. Any outbreak or significant increase in nosocomial infections above the norm or baseline in nursing home residents or employees must be reported to NYSDOH. This can be done electronically via the Nosocomial Outbreak Reporting Application (NORA). NORA is a NYSDOH Health Commerce System Application. Alternately, facilities may fax an Infection Control Nosocomial Report Form (DOH 4018) on the DOH public website.
c. Facilities are expected to conduct surveillance that is adequate to identify background rates and detect significant increases above those rates. Healthcare associated infection outbreaks may also be reported to the LHD.
d. A single case of a reportable communicable disease or any unusual disease (defined as a newly apparent or emerging disease or syndrome that could possibly be caused by a transmissible infectious agent or microbial toxin) must be reported to the local health department (LHD) where the patient/resident resides. In addition, if the reportable communicable disease is suspected or confirmed to be acquired at the NYSDOH regulated Article 28 nursing home, it must also be reported to the NYSDOH. This can be done electronically via the NORA, or, by faxing an Infection Control Nosocomial Report Form (DOH 4018).
e. Reports must be made to the local health department in the county in which the facility is located (as the resident’s place of residence) and need to be submitted within 24 hours of diagnosis. However, some diseases warrant prompt action and should be reported immediately by phone.
f. Categories and examples of reportable healthcare-associated infections include:
g. An outbreak or increased incidence of disease due to any infectious agent (e.g. staphylococci, vancomycin resistant enterococci, Pseudomonas, Clostridioides difficile, Klebsiella, Acinetobacter) occurring in residents or in persons working in the facility.
h. Intra-facility outbreaks of influenza, gastroenteritis, pneumonia, or respiratory syncytial virus.
i. Foodborne outbreaks.
j. Infections associated with contaminated medications, replacement fluids, or commercial products.
k. Single cases of healthcare-associated infection due to any of the diseases on the Communicable Disease Reporting list. For example, single cases of nosocomial acquired Legionella, measles virus, invasive group A beta hemolytic Streptococcus.
l. A single case involving Staphylococcus aureus showing reduced susceptibility to vancomycin.
m. Clusters of tuberculin skin test conversions.
n. A single case of active pulmonary or laryngeal tuberculosis in a nursing home resident or employee.
o. Increased or unexpected morbidity or mortality associated with medical devices, practices or procedures resulting in significant infections and/or hospital admissions.
p. Closure of a unit or service due to infections.
A. Facility disinfect / clean high touch surfaces (knobs, had rails, tables etc..) on regular basis throughout the day, at a minimum twice a day with increase amount warranted based on facility activity
B. Facility should ensure ample amount of alcohol-based gel dispensers as well as a system of keep full and ready for use by staff and visitors
C. The housekeeping department will disinfect all high touch surfaces (door knobs, elevator controls, remotes, hand rails, tables, chairs etc.) with bleach twice times a day and as needed. Other disinfectants are used as well and will be listed down below.
D. Bleach is used in the water to mop as well as to wipe down all surfaces.
2a. Whirl Bath Lemon Kleen is a disinfectant which kills funguses as well as viruses and is used in conjunction with bleach.
2b. Purell Healthcare Surface Disinfectant is also used to disinfect surfaces to kill various bacteria.
E. Additional hand sanitizing stations are provided on each unit to help prevent any breakouts and are inspected daily to ensure they are filled.
F. Signs are posted all over the facility as well as handed out to ensure individuals are knowledgeable and following proper infectious control procedures to help prevent an outbreak.
7. Staff Communication:
A. All staff must see their immediate supervisor or charge nurse on their respective unit prior to working in order to receive report of residents that are presumed/ confirmed positive.
8. Vendor list for all supplies including utilities:
A. Facility has contracts with various vendors for all supplies including utilities.
9. Family visitations and packages:
A. Family members are allowed to visit with their loved ones through an entrance of the facility through the glass. The family member is positioned outside the door and the resident on the opposite side and they converse through the clear glass with no physical.
B. The resident is accompanied by an escort from the recreation department with a mask on their face to ensure safety and protocols are followed as per our policy.
C. Packages are allowed to be dropped off for residents now. The packages are dropped off at the security desk by family members and the recreation or social services staff delivers them.
10. Educational Material:
A. Material was made available for staff, residents and the public in general who wanted to educate themselves on this pandemic.
B. All employees were in-serviced on this infectious disease by the in-service coordinator. They were also given handouts to go along with the lesson plan. (refer to attached)
C. Reading material can be found at the front desk near security.
11. Social distancing:
A. All common spaces have been temporarily closed to ensure this disease is not spread amongst residents and staff alike.
B. The main dining room, smoke room, rehab gym as well as recreation area located on the 1st floor has been closed due to social distancing practices.
C. The recreation department now holds activities upstairs in the hallway which allows them enough room to keep each participating resident 6 feet apart.
D. The rehab department renders rehab at the bed side to each resident in their rooms. They are also utilizing the hallways as well upstairs which allows for proper social distancing.
12. Ensure adequate staffing levels during a pandemic:
– Before requesting volunteers, we must first assess the situation to determine whether or not we can provide certain services for volunteers such as (food and lodging).
– Requests for volunteers can be made via https://www1.nyc.gov/site/helpnownyc/get-help/organizations.page
Social Media (Facebook, Instagram, LinkedIn)
Job posting sites (indeed)
– An appropriate level of supervision must be provided to volunteers at all times. The supervisor’s job is to ensure that volunteers understand their responsibilities, know how to carry out their work, and are meeting performance and standards, especially in regards to safety. Supervision ensures volunteers are correctly utilizing necessary supplies and equipment and not creating a situation which may cause harm to others. Volunteer coordinators and other employees working with volunteers should be trained to recognize signs of critical incident stress among volunteers.
– Volunteers who are deployed must be accounted for from the initiation of assignments through demobilization.
– Developing a plan for orienting, training and supervising volunteers is essential to the successful involvement of volunteers in disaster response and recovery efforts. Training helps ensure safe volunteer operations, tells volunteers they are being taken seriously, helps maintain consistency and quality of services, and helps protect the interest and assets of the facility.
– Volunteers should be oriented to the organization and the disaster situation. The facility’s disaster mission, key policies and procedures, safety instructions, a tour of necessary facility sites.
– Volunteers are responsible for maintaining the confidentiality of all information to which they are exposed while serving as volunteer, whether this information involves a single staff, volunteer, resident, or other person or involves overall facility business.
– Failure to maintain confidentiality may result in termination of the volunteer’s relationship with the facility or other corrective action.
– Healthcare professional Volunteers
1. These are volunteers that have some type of medical expertise, such as physicians, nurses, EMTs, and CNA’s.
2. The facility will ensure volunteers have all the information and resources they need to adequately respond to an emergency and maintain existing standards of care.
3. Healthcare professional Volunteers must have a current valid, unencumbered license
4. Orientation and Training for Healthcare Professional Volunteers will include shadowing and/or mentoring for 1-2 hours, a tour showing volunteers storage and resource locations, reporting structures, and other important places.
13. Emergency Contact numbers:
Local Fire Department – 718 467 6268
Local Police Department – 718 318 4200
NYDOH Regional Office – 212 417 5550
NYSDOH Duty Officer – 866 881 2809
New York State Watch Center – 516 292 2200
14. Herds reporting:
A. All covid-19 data for the facility is submitted electronically via herds daily by the Director of nursing.
15. Testing of employees:
A. A technician comes out to the facility twice a week to test the staff.
B. The specimens are then sent over to contracted laboratory for processing and in 72 hours results are posted on the labs portal.
C. Personnel that work in more than one facility can bring in documentation from the facility to fulfill the testing requirement.
D. Asymptomatic personnel who are being tested may work while waiting for the test results.
E. Any personnel who test positive cannot work for 14 days from the date of testing regardless of symptoms or history of Covid.
F. Any positive results will be communicated to the employee by the D.N.S/designee.
64 11 Beach Channel Drive
Arverne, NY, 11692