Clinical Surveillance Resources

When it comes to resident care, your role is to see the bigger picture and to put systems in place that not only protect your residents but also promote their best possible function. Preventing and identifying medical errors and adverse events is imperative for facility leaders. Using the latest technologies to synthesize resident care outcome data -- in complement with implementing proper bedside and clinical decision-making protocols -- are part of a strong clinical surveillance system that bolsters quality assurance. Find out what you need to know and how your facility can take evidence-based steps to improve care. 

  • Patterns in COVID-19 Cases and Deaths in Long-Term Care Facilities in 2020: Kaiser Family Foundation Review (1/21)

    By Kaiser Family Foundation - January 18, 2021

    For some regions of the country, recent months have brought the worst COVID-19 outbreaks in long-term care facilities since the start of the pandemic, a new KFF analysis of state-reported cases and death shows, underscoring the importance of current efforts to vaccinate this high priority group. A second, related analysis synthesizes the findings of 30 studies that examined potential factors associated with COVID-19 cases and deaths in long-term care facilities.

    KFF held a web briefing yesterday to review this latest data on COVID-19 cases and deaths in long-term care facilities and examine how the effort to vaccinate residents and staff in long-term care settings is going, challenges experienced so far, and opportunities for improvement. 

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  • World Health Organization: Updated COVID-19 Interim Guidance for LTC Facilities (1/21)

    By WHO - January 12, 2021
    Infection prevention and control guidance for long-term care facilities (including NFs and SNFs) in the context of COVID-19 Interim guidance

    8 January 2021

    This document is an update of the guidance published on 21 March 2020 and contains new evidence and guidance, including the following:

    • updated results from published studies on:
      • the epidemiology and extent of SARS-CoV-2 infection among residents and staff in long-term care facilities (LTCFs);
      • the effectiveness of infection prevention and control (IPC) precautions to prevent SARS-CoV-2 transmission in LTCFs;
      • the impact of IPC precautions on mental and physical health and well-being of older people, and in particular people with dementia or other mental health or neurological disorders;
    • updated advice on IPC precautions to prevent the spread of SARS-CoV-2 and to protect health workers and caregivers of patients with suspected or confirmed COVID-19 in LTCFs;
    • advice on early detection of and testing for SARS-CoV-2 among residents and staff in LTCFs;
    • advice on policies for visitors to LTCFs and additional considerations on minimizing the mental and physical health impacts of restrictions and IPC precautions implemented in the context of COVID-19.
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  • FDA Alert: SARS-CoV-2 Viral Mutation Could Cause False Negatives on Tests, but Overall Risk Is Low (1/21)

    By FDA - January 11, 2021

    The U.S. Food and Drug Administration is alerting clinical laboratory staff and health care providers that the FDA is monitoring the potential impact of viral mutations, including an emerging variant from the United Kingdom known as the B.1.1.7 variant, on authorized SARS-CoV-2 molecular tests, and that false negative results can occur with any molecular test for the detection of SARS-CoV-2 if a mutation occurs in the part of the virus’s genome assessed by that test. The SARS-CoV-2 virus can mutate over time, like all viruses, resulting in genetic variation in the population of circulating viral strains, as seen with the B.1.1.7 variant. The FDA is taking additional actions to ensure authorized tests remain accurate by working with test developers and conducting ongoing data analysis to evaluate all currently authorized molecular tests. The FDA believes the risk that these mutations will impact overall testing accuracy is low.

    “The FDA will continue to monitor SARS-CoV-2 genetic viral variants to ensure authorized tests continue to provide accurate results for patients,” said FDA Commissioner Stephen M. Hahn, M.D. “While these efforts continue, we are working with authorized test developers and reviewing incoming data to ensure that health care providers and clinical staff can quickly and accurately diagnose patients infected with SARS-CoV-2, including those with emerging genetic variants. At this time, we believe the data suggests that the currently authorized COVID-19 vaccines may still be effective against this strain. The FDA will continue to keep health care providers and the public informed of any new information as it becomes available.”

    The FDA has been monitoring SARS-CoV-2 viral mutations, and potential impact on testing, throughout the pandemic. The presence of SARS-CoV-2 genetic variants in a patient sample can potentially change the performance of a SARS-CoV-2 test. Tests that rely on the detection of multiple regions of the genome may be less impacted by genetic variation in the SARS-CoV-2 genome than tests that rely on detection of only a single region.

    Three currently authorized molecular tests, MesaBiotech AcculaTaqPath COVID-19 Combo Kit, and Linea COVID-19 Assay Kit, may be impacted by genetic variants of SARS-CoV-2, but the impact does not appear to be significant. Importantly, the detection pattern that appears with the TaqPath and Linea diagnostic tests when certain genetic variants are present may help with early identification of new variants in patients to reduce further spread of infection. The recently identified B.1.1.7 variant has been associated with an increased risk of transmission, therefore early identification of this variant in patients may help reduce further spread of infection.

    The FDA has reminded clinical laboratory staff and health care providers about the risk of false negative results with all laboratory tests, including molecular tests. Laboratories should expect some false results to occur even when very accurate SARS-CoV-2 tests are used. Today’s announcement also provides important information and recommendations for clinical laboratory staff and health care providers who use molecular tests for the detection of SARS-CoV-2.

    The FDA will continue to communicate with the public as we have additional information to share. The FDA encourages stakeholders to report any adverse events or suspected adverse events experienced with molecular tests for detection of SARS-CoV-2. Voluntary reports can be submitted through MedWatch, the FDA Safety Information and Adverse Event Reporting program. Health care personnel and clinical laboratory staff employed by facilities that are performing COVID-19 testing should follow the reporting requirements for authorized laboratories as specified in the test’s Emergency Use Authorization. Prompt reporting of adverse events can help the FDA identify and better understand the risks associated with medical devices.

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  • CDC COVID-19 Vaccination Toolkit for SNFs/NFs (1/21)

    By CDC - January 05, 2021

    Long-Term Care Facility Toolkit: Preparing for COVID-19 Vaccination at Your Facility

    Answering Common Questions About COVID-19 Vaccines

    This toolkit provides long-term care facility (LTCF) administrators and clinical leadership with information and resources to help build vaccine confidence among healthcare personnel (HCP) and residents. You play a critical role in providing trusted information and ensuring high COVID-19 vaccination coverage in your facility.

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  • COVID-19 Vaccinations: Importance for Residents and Staff (12/20)

    By CDC - December 29, 2020
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  • Considerations for Use of SARS-CoV-2 Antigen Testing in Nursing Homes (12/20)

    By CDC - December 28, 2020
    This document provides a summary of considerations for use of SARS-CoV-2 (the virus that causes COVID-19) antigen testing in nursing homes and is intended for nursing home providers and state and local public health departments.

    Also see: Guidance for SARS-CoV-2 Point-of-Care Testing

    UPDATE: 


    As of December 28, 2020

    • Updated To whom long-term care facilities (LCTFs) should report point-of-care antigen testing data under “Reporting requirements for SARS-CoV-2 tests”
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  • ACIP Interim Recommendation for Use of Pfizer-BioNTech and Moderna COVID-19 Vaccines (12/20)

    By CDC - December 24, 2020
    The Advisory Committee on Immunization Practices’ Interim Recommendation for Use of Pfizer-BioNTech COVID-19 Vaccine — United States, December 2020 Early Release / December 13, 2020 / 69


    Summary

    What is already known about this topic?

    On December 11, 2020, the Food and Drug Administration issued an Emergency Use Authorization for the Pfizer-BioNTech COVID-19 vaccine.

    What is added by this report?

    On December 12, 2020, after an explicit, evidence-based review of all available data, the Advisory Committee on Immunization Practices (ACIP) issued an interim recommendation for use of the Pfizer-BioNTech COVID-19 vaccine in persons aged ≥16 years for the prevention of COVID-19.

    What are the implications for public health practice?

    The recommendation for the Pfizer-BioNTech COVID-19 vaccine should be implemented in conjunction with ACIP’s interim recommendation for allocating initial supplies of COVID-19 vaccines.


    The Advisory Committee on Immunization Practices’ Interim Recommendation for Use of Moderna COVID-19 Vaccine — United States, December 2020

    Summary

    What is already known about this topic?

    On December 18, 2020, the Food and Drug Administration issued an Emergency Use Authorization (EUA) for the Moderna COVID-19 vaccine.

    What is added by this report?

    On December 19, 2020, after a transparent, evidence-based review of available data, the Advisory Committee on Immunization Practices (ACIP) issued an interim recommendation for use of the Moderna COVID-19 vaccine in persons aged ≥18 years for the prevention of COVID-19.

    What are the implications for public health practice?

    Use of all COVID-19 vaccines authorized under an EUA, including the Moderna COVID-19 vaccine, should be implemented in conjunction with ACIP’s interim recommendations for allocating initial supplies of COVID-19 vaccines.

     


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  • CDC Strategies for Optimizing the Supply of PPE and Other Equipment (12/20)

    By CDC - December 22, 2020

    The Centers for Disease Control and Prevention (CDC) offers strategies for optimizing the supply of:

    N95 respirators

    Face masks

    Isolation gowns

    Eye Protection

    Gloves

    Powered Air-Purifying Respirators (PAPRs)

    Elastomeric respirators

    Ventilators

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  • Dec. 22 CMS-CDC Nursing Home Stakeholder Call on COVID-19 Vaccinations

    By CMS and the CDC - December 21, 2020

    Date:                          Tuesday, December 22

    Time:                          1:00 – 2:00 pm ET

    Toll Free Dial-In:       833-614-0820  

    Access Passcode:     7979889

    Overview: Please join CDC and CMS for this call with Nursing Homes focused on COVID 19 vaccination among residents and staff. During this call, you’ll receive:

     

    ·         Updates on Pharmacy Partnership for Long-Term Care Program;

    ·         Critical clinical, safety, and infection prevention and control considerations associated with implementation;

    ·         Communication resources you can use to address resident and staff questions and concerns; and

    ·         General reminders for the holiday season.

    ·         A questions and answer session will follow updates.

     

    Conference lines are limited. We encourage you to join via audio webcast, either on your computer or smartphone web browser. These calls are not intended for the press.

     

    For More Information:

    ·         Coronavirus.gov

    ·         CMS Current Emergencies

    ·         Podcast and Transcripts  view transcripts and listen to audio recordings of COVID-19 calls

    ·         Coronavirus (COVID-19) Partner Toolkit view this webpage for the most current information including call schedule changes.

     

     


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  • AHRQ Study: Transforming Medication Regimen Review With Telemedicine to Prevent Adverse Events (12/20)

    By AHRQ - December 21, 2020
    Transforming the medication regimen review process using telemedicine to prevent adverse events

    AHRQ News Now:

    KaneGill SL, Wong A, Culley CM, et al. J Am Geriatr Soc. 2020;Epub Nov 25.

    Medication reconciliation and medication regimen reviews can reduce adverse drug events (ADEs) in older adults. This study assessed the impact of a pharmacist-led, patient-centered telemedicine program to manage high-risk medications during transitional and nursing home care. The program included telemedicine-based medication reconciliation at admission and medication regimen reviews throughout the nursing home stay, coupled with clinical decision support. Residents in the program experienced fewer adverse drug events compared to a usual care group. This innovative model has the potential to further reduce medication errors in nursing home residents.

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  • CDC Post-COVID-19 Vaccine Considerations for Residents (12/20)

    By CDC - December 14, 2020

    Infection prevention and control considerations for residents of long-term care facilities with systemic signs and symptoms following COVID-19 vaccination

    Note: Strategies are needed by long-term care facilities to appropriately evaluate and manage post-vaccination signs and symptoms among their residents.  The approach described in this document is intended to balance:

    ·  the risk of unnecessary testing and implementation of Transmission-Based Precautions for residents with only post-vaccination signs and symptoms with that of

    ·  inadvertently allowing residents with infectious COVID-19 or another transmissible infectious disease to expose others in the facility.

    While this guidance is intended for long-term care facilities, it could also be applied to patients in other healthcare settings.  These considerations are based on the current understanding of signs and symptoms following COVID-19 vaccination, including timing and duration, and might change as experience with the vaccine accumulates.

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  • Senate Special Committee on Aging: New Report Looks at COVID-19 Nursing Home Infections and Death Rates (12/20)

    By US Senate - December 13, 2020

    TO DATE, MORE THAN 104,000 RESIDENTS AND WORKERS IN LTC FACILITIES HAVE DIED FROM COVID-19

    Washington, D.C. – As the Nation enters what experts predict will be the most severe months of the COVID-19 pandemic, the number of COVID-19 deaths and infections among residents and workers in nursing homes is rapidly rising. U.S. Senators Bob Casey (D-PA), Ranking Member of the Special Committee on Aging, and Ron Wyden (D-OR), Ranking Member of the Finance Committee, are releasing a report that shows that the already dire situation in nursing homes is worsening.

    • In November, more than 15 nursing home residents died from COVID-19 per hour, with 19 residents dying each hour during the week of November 22, 2020, the most recent week reported.

    • The number of weekly COVID-19 deaths among nursing home residents has increased 133 percent since Labor Day, and 96 percent among nursing home workers during the same period.

    • Workforce shortages have increased since Labor Day: In November, one in six nursing homes nationwide reported that they do not have a sufficient workforce.

    These new findings serve as a warning for what is to come if Congress does not come together to alleviate the COVID-19 crisis in nursing homes.

    “It’s with great sadness that we are once again giving a grim update on the toll that COVID-19 is continuing to take on nursing homes. It’s abundantly clear that inaction has contributed to the loss of more than 104,000 mothers, fathers, grandparents, friends and neighbors who lived and worked in nursing homes and long-term care facilities across the country,” said Senators Casey and Wyden. “Experts are predicting that we are heading into the most severe months of the COVID-19 pandemic, marred by climbing caseloads and increasing stress on our Nation’s health care system. We are once again calling on our colleagues to work with us to pass a comprehensive COVID relief bill to bring urgently needed help to nursing homes, residents and workers.”

    Since the beginning of this public health crisis, Senators Casey and Wyden have been sounding the alarm that the Trump Administration has not done enough to stop the virus and its devastating effects on nursing homes and long-term care facilities. In addition to calling for increased transparency and data on COVID-19 in nursing homes, they also released two reports: The Cost of Inaction: 11 Deaths an Hour and COVID-19 in Nursing Homes: How the Trump Administration Failed Residents and Workers. Both reports provided a series of recommendations outlining the urgent actions that are needed to address the crisis in nursing homes. These include ensuring comprehensive data collection, providing states and nursing homes with funding, supplying adequate PPE and testing, investing in home and community-based services, supporting nursing home workers with premium pay, overtime and other essential benefits and upholding resident rights and resuming visitation safely.

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  • Adverse Events in Italian Nursing Homes During the COVID-19 Pandemic (11/20)

    By AHRQ - November 26, 2020

    Lombardo FL, Salvi E, Lacorte E, et al. Front Psychiatry. 2020

    Long-term care and skilled nursing facilities are particularly vulnerable to COVID-19 infection; this increased risk may present other threats to patient safety. This survey of nursing homes in Italy found that one third of facilities reported at least one adverse event during the early weeks of the COVID-19 pandemic. Adverse events were more likely to occur in nursing homes with higher bed capacities, increased use of psychiatric drugs, and use of physical restraints. These findings can inform nursing homes creating mitigation plans.

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  • Higher Incidence of Adverse Events in Isolated Patients Compared With Non-isolated Patients: A Cohort Study (11/20)

    By AHRQ - November 24, 2020
    Jiménez-Pericás F, Gea Velázquez de Castro MT, Pastor-Valero M, et al. BMJ Open. 2020;10(10):e035238.

    Isolation for infection prevention and control, albeit necessary, may result in unintended consequences for patients (e.g., less attention, suboptimal documentation and communicationhigher risk of preventable adverse events [AEs]). This prospective cohort study found that the incidence of all AEs and preventable AEs were significantly higher in isolated patients compared to non-isolated patients, primarily caused by healthcare-associated infections. These findings highlight the importance of training and safety culture when providing care to patients in isolation, particularly given the expanded use of isolation due to the COVID-19 pandemic.

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  • CDC Infection Prevention and Control Assessment (ICAR) Tool for Nursing Homes Preparing for COVID-19 UPDATED (11/20)

    By CDC - November 23, 2020

    Infection Control Assessment and Response (ICAR) tools are used to systematically assess a healthcare facility’s infection prevention and control (IPC) practices and guide quality improvement activities (e.g., by addressing identified gaps).

    This tool is an update to the previous ICAR tool for nursing homes preparing for COVID-19. Notable changes as of November 20, 2020 include:

    • Additions to reflect updated guidance such as SARS-CoV-2 testing in nursing homes
    • Increased emphasis on the review of Personal Protective Equipment (PPE) use and handling
    • Addition of sections to help guide a video tour as part of a remote TeleICAR assessment or in-person tour of a nursing home
    • Addition of an accompanying facilitator guide to aide with the conduction of the ICAR and create subsequent recommendations for the facility

    This updated ICAR tool is a longer but more comprehensive assessment of infection control practices within nursing homes. Due to the addition of example recommendations to aid the facilitator during the process of conducting an ICAR, the facilitator guide version of the tool appears even longer. Facilitators may decide whether to use the tool in its entirety or select among the pool of questions that best fit their jurisdictional needs and priorities as part of quality improvement efforts.

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