On July 23, 2020, the Indiana State Department of Health (ISDH) updated its COVID-19 Long-Term Care Facility Infection Control Guidance and Standard Operating Procedure,to include the changes to the CDC’s guidance on Transmission-Based Precautions for residents and Return to Work Criteria for health care personnel For IHCA/INCAL’s summary on the recent updates to the CDC’s Transmission-Based Precautions and Return to Work Criteria, please click here.
The additions to ISDH’s Infection Control Guidance can be found in items #14 and #15 in the document. In addition to summarizing the changes to the Transmission-Based Precautions and Return to Work Criteria, ISDH’s Infection Control Guidance notes that in some instances, a test-based strategy could be considered for discontinuing Transmission-Based Precautions earlier than if a symptom-based strategy is used. However, some individuals will have prolonged viral shedding, limiting the utility of the test-based strategy and indicating the use of the symptom-based strategy instead. A test-based strategy could also be considered for some patients (i.e., those who are severely immunocompromised) in consultation with local infectious diseases experts if concerns exist for the patient being infectious for more than 20 days.
The remainder of ISDH’s Infection Control Guidance remains the same and states that colors can be used on facility maps to help visualize testing results to facilitate the moving of residents, as follows:
- COVID-19 Positive (Red): These are residents who are confirmed COVID-19 positive and who, based on CDC criteria, still warrant transmission-based precautions. These residents should be placed in transmission-based precautions (droplet and contact) and cohorted into a COVID-19 wing, floor, or building. If facilities have dedicated COVID-19 memory units, residents may continue to socialize so long as there are no COVID-19 negative residents or residents with unknown COVID-19 status in these units.
- Unknown COVID-19 Status (Yellow): These are residents whose COVID-19 status is unknown, including residents who have been tested and are waiting on results and residents who are admitted or readmitted to a facility after they are likely to have been exposed to COVID-19. All residents in this category warrant transmission-based precautions (droplet and contact) and should, if possible, be isolated from residents with a known COVID-19 status, both positive and negative. Residents in this category who have been tested and are waiting on results may stay in their facility location until test results are back. This can include remaining with a roommate who is known to be COVID-19 positive if no other private rooms are available. After test results are back, residents should be moved to the appropriate area of the facility.
- For residents who ultimately test negative for COVID-19 but who have had a roommate who is positive, it is not recommended to place them with another roommate for fourteen (14) days, assuming they have not developed symptoms or tested positive.
- Residents in yellow status who do not undergo testing can be transferred to the COVID-19 negative areas of the facility if they remain afebrile and without symptoms for fourteen (14) days after their exposure or admission. Testing at the end of this period can be done by the facility to increase the certainty that the resident is not infected. Residents who develop symptoms while being observed should be tested and moved accordingly.
- COVID-19 Negative (Green): These include residents who are asymptomatic and not suspected to have COVID-19, asymptomatic residents who have had a negative test, and residents who have recovered from COVID-19 and meet CDC criteria for removing transmission-based precautions. If despite negative testing there remains clinical uncertainty regarding a resident’s COVID-19 status, the resident should be placed in isolation (yellow status) until additional testing can be done. Even among COVID-19 negative residents, precautions should remain in place for all health care providers, including masks being worn during direct care.