***IHCA is aware that the CDC has also issued updated guidance for infection control and long term care on September 10, 2021. IDH has indicated that facilities can follow either IDH or CDC guidance and not be cited for following CDC guidance that differs from current IDH guidance. We expect IDH to update their guidance to conform with CDC guidance the week of September 20.***
The Indiana Department of Health posted an updated COVID-19 Clinical Guidance document that reorganizes many existing guidance that LTC facilities have already been following. The updated COVID-19 Clinical Guidance document also references other updated guidance that IDH has also updated, the COVID-19 Regulatory Visitation and Activities Guidance and COVID-19 LTC Infection Control Guidance. All three of these new guidance documents have also been incorporated into the COVID-19 LTC Toolkit (a link for which can be found on the IHCA’s main COVID-19 page).
The COVID-19 Clinical Guidance restates prior guidance in the areas of guiding principles, the prevention of introduction of COVID-19 into a facility, exposure definitions, treatment for symptomatic individuals, protocol for known COVID-19 cases (both residents and heath care personnel/return to work), staffing shortage protocols, resident assessment, new admission and re-admissions, outbreaks, reporting requirements, residents leaving the facility, and testing.
It is critical that facilities read this guidance and compare it to current facility policies. Much of what is contained in this COVID-19 Clinical Guidance is restatement of existing best practice.
Key reminders and areas:
- HCP wearing proper PPE caring for a known COVID-19 case is not considered an exposure.
- Antigen Test Interpretation/Algorithm
- Unvaccinated staff with exposure excluded from work for 14 days, testing at day 5-7
- Vaccinated staff with high-risk exposure require immediate testing and at day 5-7 and do not need to be excluded from work when asymptomatic.
- Vaccinated staff with exposure (not high risk) testing at days 5-7 and do not need to be excluded from work when asymptomatic.
- Treated the same irrespective of vaccination status. Residents placed in TBP. Staff should be tested, restricted from work until isolation period is complete or alternative diagnosis confirmed.
Known COVID-19 Cases
- Residents in red zone for 10 days when mild/moderate; in red zone for 20 days with severe/immunocompromised.
- Assess 3x daily and discusses treatment options with medical director (monoclonal antibody therapy should be considered)
- Heath Care Personnel isolate at home and follow CDC return to work criteria
- In case of staffing shortage, the facilities with active COVID-19 cases can continue to allow asymptomatic COVID-positive HCP to work in the COVID-19 unit (red zone) of the facility.
- Refer to CDC Staff Shortage Mitigation Strategies that permit asymptomatic high-exposed HCPs to return to work earlier with additional daily screening and reporting.
- Determine Crisis capacity strategy implementation.
- If staffing shortages persist beyond implementation of mitigation, as a last resort HCPs with suspected or confirmed cases and are well enough/willing to work can work under certain circumstances.
- When possible, HCPs working the Red Unit should be dedicated. If this is not possible, use the following guidance:
- Assure that red and yellow zone is clearly marked and each resident’s door has TBP signage for proper PPE.
- Recommend using conventional PPE for all staff who cross zones during their shift. See the guidance in COVID-19 Infection Control Guidance in Long Term Care Facilities section of SOP.
- Staff may be shared in the red and yellow zone as your first mitigation, working from yellow zone to red zone.
- If using the same staff for both green and red zone, perform frequent infection control rounds to assure proper PPE donning, doffing and hand hygiene. Working from green zone, then yellow then red zone.
- Consider staffing with vaccination status of your team in mind.
- Assure full cohorting of equipment and supplies per zone.
- Refer to Crisis Capacity Staffing from CDC
New Admissions and Readmissions
- Residents that are outside of the facility for more then 24 hours are a readmission.
- All new admissions and readmissions must be screened and treated according to screening results.
- Unvaccinated new admissions and readmissions should be placed in TBP even if they have a negative test.
- Full vaccinated new admissions and readmissions do not need to be in TBP if asymptomatic and pass screening protocol. If any prolonged contact with a known positive or symptom is present, then the fully vaccinated resident should be treated according to exposure protocol.
- All new admissions should be given a POC test. If positive, follow up with PCR and resident place in yellow zone until PCR results returned. Resident moved to red zone if positive confirmed by PCR.
- All readmissions should be monitored for symptoms and POC test may be considered at 3-5 days based on screening or high-risk activities.
- No change. Reminder that outbreak testing is not triggered when a staff member has a community-acquired case (exposed outside of the facility and was not in the facility while potentially infectious).
Residents Leaving the Facility
- Residents that leave for routine and/or frequent medical appointments for fewer than 24 hours must be screened upon return. Quarantine is not recommended when the resident does not have close contact with a known positive. Testing upon return from a medical appointment is not required – follow screening protocol.
- Residents should observe core principles of infection control while outside of the facility
Routine Staff Testing
- During routine testing based on county positivity, unvaccinated staff do not need to be routinely tested.
- During Outbreak Testing – all vaccinated and unvaccinated staff and residents are subject to testing protocol
- When Symptomatic Individual is identified – all all vaccinated and unvaccinated staff and residents with symptoms are subject to testing protocol