As COVID-19 spreads and the demand for personal protective equipment (PPE) increases, nursing homes across the country are experiencing or preparing for shortages of PPE. To help providers prioritize and make difficult but critical decisions about PPE use, the Centers for Disease Control and Prevention (CDC) has developed a framework, COVID-19: Strategies to Optimize the Supply of PPE and Equipment, which CDC officials discussed at the March 25 Clinician Outreach and Communication Activity (COCA) call, COVID-19 Update: Optimization Strategies for Healthcare PPE. Options for prioritizing and extending existing PPE supplies include the following:

 

Utilize engineering and administrative controls

Facilities should be maximizing their use of administrative and engineering controls to reduce exposures and help extend their PPE supplies, says David Kuhar, MD, the lead for the CDC’s COVID-19 Hospital Infection Prevention Team.

Engineering controls include “maximizing use of physical barriers (e.g., glass or plastic windows) that can potentially eliminate the need for PPE use in selected situations,” says Kuhar. Additional engineering controls include closing the curtains between residents and maintaining ventilation systems. Ventilation systems should provide air movement from a clean to contaminated flow direction.

 

Driven by the ongoing opioid crisis, drug diversion among healthcare workers remains a significant, often underrecognized problem, creating significant risk for long-term care facilities in addition to the individual risks for addicted staff or even residents’ family members and the harm to residents from inadequately managed pain. F-tags that could come into play as a result of drug diversion include:

 

• F602 (Free From Misappropriation/Exploitation),

• F608 (Reporting of Reasonable Suspicion of a Crime),

• F697 (Pain Management),

• F755 (Pharmacy Services/Procedures/Pharmacist/Records), and

• F761 (Label/Store Drugs and Biologicals).

 

Surveyors also may refer providers to the Drug Enforcement Administration (DEA), local law enforcement, State Boards of Nursing, Pharmacy, and Nursing Home Administrators, and/or other agencies as required by state law, according to Additional Investigatory Activities Related to Allegations of Drug Diversion in F602 in Appendix PP, “Guidance to Surveyors for Long-Term Care Facilities,” of the State Operations Manual.

 

Implementing the following seven steps can help directors of nursing services (DNSs) reduce the risk of drug diversion:

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes coronavirus disease (2019-nCoV or COVID-19), is spreading rapidly in nursing homes across the country. On March 23, the Centers for Medicare & Medicaid Services (CMS) announced that 147 nursing homes across 27 states have at least one resident with COVID-19, according to data from the Centers for Disease Control and Prevention (CDC). The number of providers with internal spread is increasing as well. For example, on March 25, news reports indicated that at least 16 residents and four staff members tested positive for COVID-19 in a West Virginia nursing home. Nursing homes that do not yet have COVID-19 in their facility should be actively working to mitigate the risk to residents and staff. Implementing the following strategies can assist in this effort:

 

Constantly monitor key infection prevention practices

Infection prevention auditing should highlight two areas:

 

* Hand hygiene. “From a self-inoculation perspective, the hands are the key,” stresses Michael Bell, MD, deputy director of the Division of Healthcare Quality Promotion at the CDC. “If you were to touch a soiled surface, you could end up with infectious material on your hands. If you then touch your eyes, nose, or mouth without washing your hands first, then you could deliver the infectious materials to yourself. Hand hygiene either in the form of alcohol-based hand gel or soap and water is the key to breaking that transmission. Simply walking into a room that might have something on the surface is not associated with any recognized risk of transmission.”

On a day-to-day basis, the DNS can become so busy with staff and resident care that they completely lose track of employee files. However, the DNS is often either directly responsible for or works with human resources to manage employee files. Compiling and maintaining these files needs to be a priority in order to stay in compliance with survey requirements, avoid legal hurdles, and have a reference of past behavior when it’s time to evaluate or promote staff.

To keep these important documents up to date, here’s what the DNS should know about employee files:

The potential devastation that the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes coronavirus disease (2019-nCoV or COVID-19), could wreak on the American public and the nation’s healthcare system is becoming more apparent every day. As of 8:47 p.m. EDT on March 17, there are 108 deaths and 6,362 confirmed COVID-19 cases across the country, and the U.S. pandemic now has both a West Coast epicenter and an East Coast epicenter: Washington, which has 1,076 confirmed cases, and New York, which has 1,706 confirmed cases, according to the COVID-19 Global Case Tracker from the Coronavirus Resource Center at the Johns Hopkins University of Medicine.

Sadly, these numbers are already outdated because the number of new cases increases exponentially daily, if not hourly, as testing expands. The March 17 data shows an increase of more than 1,000 cases in 24 hours—largely driven by new cases identified in New York. However, West Virginia is the sole state that has reported no confirmed or presumptive positive COVID-19 cases, and California, in addition to New York and Washington, is particularly affected, according to data from the Centers for Disease Control and Prevention (CDC).