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The Center for Clinical Standards and Quality Survey & Certification Group released the revised guidance on September 23, 2022.
What you need to know:
Changes and revisions:
- Updated guidance for face coverings and masks during visits
- Removed vaccination status from the guidance and is no longer used to inform source control, screening testing, or post-exposure (work restriction, quarantine) recommendations.
- Standalone guidance for nursing homes is being archived and any setting specific recommendations has been added to Section 3 of the main guidance.
The QSO memorandum can be accessed here.
Summary of Revisions with Core Principles of COVID-19 Infection Prevention:
- Facilities should provide guidance at entrance to visitors of the following:
- Recommended actions for visitors who have a positive viral test for COVID-19
- Symptoms of COVID-19
- Action if a person has had close contact with someone with COVID-19
- Visitors with confirmed COVID-19 infection or compatible symptoms should defer non-urgent in-person visitation until they meet CDC criteria for healthcare settings to end isolation.
- Visitors who have had close contact with someone with COVID-19 infection, it is safest to defer non-urgent in -person visitation until 10 days after close contact if they meet criteria described in CDC healthcare guidance.
Continue to follow the other core principles of hand hygiene, Appropriate use of PPE, Institutional signage throughout the facility, cleaning and disinfecting high-frequency touched surfaces in the facility often and visitation areas, staff use of PPE, effective cohorting, and resident and staff testing conducted as required at 42 CFR 483.80(h) – (see QSO-20-38-NH) found here.
Indoor Visitation:
- Facilities must support a resident’s right and always allow indoor visitations for all residents as permitted under the requirements of participation.
- During peak times of visitation and large gatherings (parties, events) facilities should encourage physical distancing.
What you need to know about changes related to face coverings and masks during visits:
- If the nursing home’s county COVID-19 community transmission is high, everyone in a healthcare setting should wear face coverings or masks.
- If the nursing home’s county COVID-19 community transmission is not high, the safest practice is for residents and visitors to wear face coverings or masks, however, the facility could choose not to require visitors wear face coverings or masks while in the facility, except during an outbreak. The facility’s policies regarding face coverings and masks should be based on recommendations from CDC state and local health departments and individual facility circumstances.
- Visitors when alone in the resident’s room or in a designated visitation area, may choose not to wear face coverings or masks and may choose to have close contact.
- Roommates are “not alone,” and masks are recommended.
- Visitors and residents should be advised of risks associated with physical contact prior to visit.
- Nursing homes should use the Community Transmission Level metric not the Community Level metric.
- Residents in transmission-based precautions (TBP) or quarantine can still receive visitors but not recommended. The visit should take place in the resident’s room with TBP personal protective equipment (PPE) if available. Note: Facilities are not required to provide PPE to visitors.
What you need to know about Indoor Visitation during an Outbreak Investigation
- Outbreak investigation is initiated when a single new case of COVID-19 occurs among a resident or staff to determine if others have been exposed.
- Begin outbreak testing (not earlier than 24 hours after the exposure, if known) begin outbreak testing in accordance with CMS and CDC:
Facilities are reminded of the following during an outbreak investigation:
- It is safer for visitors not to enter during an outbreak investigation but can be allowed to visit.
- All visitors entering the facility during an outbreak should be informed of the risk of doing so.
- Appropriate PPE should be worn, and visits should occur in the resident room.
- Visitor movement should be limited during an outbreak investigation.
- Visitors should physically distance themselves from other residents and staff, when possible.
Visitor Testing and Vaccination – no changes
- Facilities are not required to offer testing to visitors but are encouraged to do so with high levels of community transmission.
- Visitors are not required to be tested or vaccinated but encouraged to do so.
Compassionate Care Visits – no changes
- Compassionate care visits are always allowed.
Required Visitation – no changes
- Facilities shall not restrict visitation without a reasonable clinical or safety reason that is consistent with 42 CFR 483.10(f)(4)(v).
Access to the Long-Term Care Ombudsman Federal Disability Rights Laws and Protection & Advocacy (P&A) Programs – no changes
Communal Activities, Dining and Resident Outings – changes
- Communal activities and dining may occur while adhering to the core principals of COVID-19 infection prevention.
- We are reminded in the memo that the safest approach is for everyone, particularly those at high risk for sever illness, to wear a face covering.
- Residents can leave the facility as they choose.
- Facilities should advise the resident and significant others of risk and importance of adhering to core principles of infection control.
- Screen resident upon return for signs and or symptoms of COVID-19 infection and cohort and or test appropriately.
- In most circumstances, quarantine is not recommended for residents who leave the facility for less than 24 hours.
- Residents who leave the facility for 24 hours or longer should be managed as a new admission.
For questions, please contact Lori Davenport, director of clinical & regulatory affairs at ldavenport@ihca.org
About the Author
Lori Davenport, Director of Regulatory and Clinical Affairs