Infection Prevention and Control Resources

With the latest updates to the State Operations Manual, it is more important than ever to promote resident safety and well-being through infection prevention and control. A robust and successful infection control program requires many thoughtfully designed and well-operating pieces—from antibiotic stewardship and physician engagement to immunization planning and tracking, reduced hospital readmissions, and comprehensive clinical surveillance. Explore the resources below to learn how you can bolster your infection control program.

  • COVID-19: CMS QSO Memo Details Nursing Home Reopening Recommendations for State and Local Officials (5/20)

    By CMS - May 19, 2020

    • Recommendations for State and Local Officials: CMS is providing recommendations to help determine the level of mitigation needed to prevent the transmission of COVID19 in nursing homes. The recommendations cover the following items:

    o Criteria for relaxing certain restrictions and mitigating the risk of resurgence: Factors to inform decisions for relaxing nursing home restrictions through a phased approach.

    o Visitation and Service Considerations: Considerations allowing visitation and services in each phase.

    o Restoration of Survey Activities: Recommendations for restarting certain surveys in each phase.

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  • CMS COVID-19 Stakeholder Engagement Calls – Week of 5/18/20

    By CMS - May 18, 2020

    CMS hosts varied recurring stakeholder engagement sessions to share information related to the agency’s response to COVID-19. These sessions are open to members of the healthcare community and are intended to provide updates, share best practices among peers, and offer attendees an opportunity to ask questions of CMS and other subject matter experts.

    Call details are below. Conference lines are limited so we highly encourage you to join via audio webcast, either on your computer or smartphone web browser. You are welcome to share this invitation with your colleagues and professional networks. 

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  • OSHA Alert: COVID-19 Guidance for Nursing Home and LTC Facility Workers (5/20)

    By MX - May 18, 2020

    The Occupational Safety and Health Administration (OSHA) is committed to protecting the health and safety of America’s workers and workplaces during these unprecedented times. The agency will be issuing a series of alerts designed to keep workers safe. In a nursing home or long-term care facility, the following tips can help reduce the risk of exposure to the coronavirus.

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  • LTCSP Survey Resources: Surveyor Tools Updated to Include COVID-19 (5/20)

    By CMS - May 18, 2020

    This ZIP file contains resources for surveyors conducting initial surveys under the Long-term Care Survey Process (LTCSP).

     

     05/14/2020 COVID-19 Focused Survey folder Updated the following:

    • F-Tag Job Aid- changed font color of F761 to black. Removed asterisks from F885.

    • Added updated F-Tag job aide to survey resources zip file.

     

    05/08/2020 COVID-19 Focused Survey folder Updated the following:

    • Summary of the COVID-19 Focused Survey for Nursing Homes Added to offsite survey activities-telephonic interviews of residents, representatives and families. Added review communication with residents, representatives and families. In the onsite survey activity section added in the interview section-information provided to residents concerning COVID-19. In the Facility Self-Assessment added Reporting to residents, families and representatives to priority areas. Added Reporting to CDC to priority areas.

    • COVID-19 Focused Survey Protocol Added information about the review of F884 by CMS Federal Surveyors. Added ACO coding information to off-site prep. Expanded information under offsite and onsite activities.

    • Entrance Conference Worksheet Clarified language under #9. Added #13 requesting information on facility’s mechanism for reporting COVID-19 to residents, representatives, and families.

    • COVID-19 Focused Survey for Nursing Homes Added two critical elements (CE) and adjusted the CE order. #7 CE Reporting to Residents, Representatives & Families, #8 Reporting to CDC, and #9 Emergency Preparedness.

    • F-Tag Job Aid- Added tags F884 and F885

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  • CDC Long-term Care COVID-19 Resources Updated (5/20)

    By CDC - May 14, 2020

    Interim Additional Guidance for Infection Prevention and Control for Patients with Suspected or Confirmed COVID-19 in Nursing Homes

     

    Summary of Changes to the Guidance:

    Updated guidance to recommend that nursing homes:

    • Act now to implement ALL COVID-19 preparedness recommendations, even before cases are identified in their community
    • Address asymptomatic and pre-symptomatic transmission, implement source control for everyone entering a healthcare facility (e.g., healthcare personnel, patients, visitors), regardless of symptoms.
    • Dedicate an area of the facility to care for residents with suspected or confirmed COVID-19; consider creating a staffing plan for that specific location


    COVID-19 Preparedness Checklist for Nursing Homes and other Long-Term Care Settings

    Nursing homes and other long-term care facilities can take steps to assess and improve their preparedness for responding to coronavirus disease 2019 (COVID-19). This checklist should be used as one tool to develop a comprehensive COVID-19 response plan, including plans for:

    • Rapid identification and management of ill residents
    • Considerations for visitors
    • Supplies and resources
    • Sick leave policies and other occupational health considerations
    • Education and training
    • Surge capacity for staffing, equipment and supplies, and postmortem care

    The checklist identifies key areas that long-term care facilities should consider in their COVID-19 planning. Long-term care facilities can use this tool to self-assess the strengths and weaknesses of current preparedness efforts. This checklist does not describe mandatory requirements or standards; rather, it highlights important areas to review to prepare for the possibility of residents with COVID-19.

     

    Additional pages: 


     


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  • CMS COVID-19 Nursing Homes Best Practices Toolkit and New QIN-QIO Virtual Assistance (5/20)

    By CMS - May 13, 2020

    New tool provides innovative solutions for states and facilities to protect our nation’s vulnerable nursing home residents during emergency

    CMS has released a new toolkit developed to aid nursing homes, Governors, states, departments of health, and other agencies who provide oversight and assistance to these facilities, with additional resources to aid in the fight against the coronavirus disease 2019 (COVID-19) pandemic within nursing homes. The toolkit builds upon previous actions taken by the Centers for Medicare & Medicaid Services (CMS), which provide a wide range of tools and guidance to states, healthcare providers and others during the public health emergency. The toolkit is comprised of best practices from a variety of front line health care providers, Governors’ COVID-19 task forces, associations and other organizations, and experts, and is intended to serve as a catalogue of resources dedicated to addressing the specific challenges facing nursing homes as they combat COVID-19.

    “The coronavirus presents a unique challenge for nursing homes. CMS is using every tool at our disposal to protect our nation’s most vulnerable citizens and aid the facilities that care for them. This toolkit will support state, local leaders and nursing homes in identifying best practices to protect our vulnerable elderly in nursing homes” said CMS Administrator Seema Verma.  

    The toolkit provides detailed resources and direction for quality improvement assistance and can help in the creation and implementation of strategies and interventions intended to manage and prevent the spread of COVID-19 within nursing homes. The toolkit outlines best practices for a variety of subjects ranging from infection control to workforce and staffing. It also provides contact information for organizations who stand ready to assist with the unique challenges posed by caring for individuals in long-term care settings. Each state was involved in the creation of this toolkit, resulting in a robust resource that may be leveraged by a variety of entities serving this vulnerable population.

    Additionally, CMS has contracted with 12 Quality Innovation Network-Quality Improvement Organizations (QIN-QIOs) to work with providers, community partners, beneficiaries and caregivers on data-driven quality improvement initiatives designed to improve the quality of care for beneficiaries across the United States. The QIN-QIOs are reaching out to nursing homes across the country to provide virtual technical assistance for homes that have an opportunity for improvement based on an analysis of previous citations for infection control deficiencies using publicly available data found on Nursing Home Compare.

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  • CMS QSO Memo updates F-tags and COVID-19 Focused Survey Tools to Include Reporting Requirements (5/20)

    By CMS - May 07, 2020
    Interim Final Rule Updating Requirements for Notification of Confirmed and Suspected COVID-19 Cases Among Residents and Staff in Nursing Homes

    Memo # QSO-20-29-NH

    Posting Date 2020-05-06

    Fiscal Year 2020

     

    Summary

    • CMS is committed to taking critical steps to ensure America’s healthcare facilities are prepared to respond to the Coronavirus Disease 2019 (COVID-19) Public Health Emergency (PHE).

    • On May 8, 2020, CMS will publish an interim final rule with comment period. • COVID-19 Reporting Requirements: CMS is requiring nursing homes to report COVID-19 facility data to the Centers for Disease Control and Prevention (CDC) and to residents, their representatives, and families of residents in facilities.

    • Enforcement: Failure to report in accordance with 42 CFR §483.80(g) can result in an enforcement action.

    • Updated Survey Tools: CMS has updated the COVID-19 Focused Survey for Nursing Homes, Entrance Conference Worksheet, COVID-19 Focused Survey Protocol, and Summary of the COVID-19 Focused Survey for Nursing Homes to reflect COVID-19 reporting requirements.

    • COVID-19 Tags: F884 and F885.

    • Transparency: CMS will begin posting data from the CDC National Healthcare Safety Network (NHSN) for viewing by facilities, stakeholders, or the general public. The COVID-19 public use file will be available on https://data.cms.gov/.

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  • National Healthcare Safety Network Long-term Care Facility COVID-19 Reporting Module Website (5/20)

    By CDC - May 05, 2020

    CDC’s NHSN provides healthcare facilities, such as long term care facilities (LTCF) with a customized system to track infections and prevention process measures in a systematic way.

    Tracking this information allows facilities to identify problems, improve care, and determine progress toward facility and national healthcare-associated infection goals.

    The NHSN Long-term Care Facility Component is supporting the nation’s COVID-19 response by introducing a new COVID-19 Module for Long Term Care Facilities. Facilities eligible to report into the COVID-19 Module include nursing homes/skilled nursing, long-term care for the developmentally disabled, and assisted living facilities.

    The COVID-19 Module for LTCFs consists of four pathways within NHSN’s Long-term Care Facility Component:

    • Resident Impact and Facility Capacity
    • Staff and Personnel Impact
    • Supplies and Personal Protective Equipment
    • Ventilator Capacity and Supplies

    The Module enables an assessment of the impact of COVID-19 in LTCFs through facility reported information, including: 1) counts of residents and facility personnel with suspected and laboratory positive COVID-19; 2) counts of suspected and laboratory positive COVID-19 related deaths among residents and facility personnel; 3) staffing shortages; 3) status of personal protective equipment (PPE) supplies; and 4) ventilator capacity and supplies for facilities with ventilator dependent units.  The Module does not collect staff or resident-level information.

    Participation in the COVID-19 Module for LTCFs requires facilities to be actively enrolled in NHSN. LTCFs that are currently enrolled in NHSN’s LTCF Component have immediate access to the new module and may begin reporting. If your facility previously enrolled, but is no longer able to gain access, contact NHSN user support at nhsn@cdc.gov for assistance. Please do not re-enroll a previously enrolled facility.

    LTCFs that are not enrolled in NHSN may gain access to the COVID-19 Module by completing the enrollment process outlined in the Enrollment section of this page. Upon completion, the facility will gain same-day access to NHSN.

    While daily reporting will provide the timeliest data for response purposes, retrospective reporting of prior day(s) is encouraged if daily reporting is not feasible. LTCF data submission options include manual entry, CSV file submitted by individual facilities or bulk CSV file upload for multiple facilities.  NHSN, in turn, will enable state and local health departments and the Centers for Medicare and Medicaid Services (CMS) to gain immediate access to the COVID-19 data for LTCFs in their jurisdictions. COVID-19 data submitted to NHSN also will be used by CDC’s emergency COVID-19 response and by the U.S. Department of Health and Human Services’ (HHS’) COVID-19 tracking system maintained in the Office of the Assistant Secretary of Preparedness and Response.

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  • CMS FY 2020 CARES Act COVID-19 Administrative Information Funding Memo (5/20)

    By CMS - May 04, 2020

    Title Fiscal Year 2020 CARES Act Information

    Memo # 20-07-ALL

    Posting Date 2020-04-30

    Fiscal Year 2020

    Summary

    •CARES Act Funding: Congress appropriated no less than $100 million in supplemental funds to offset the costs associated with COVID-19 survey activities. This memorandum provides guidance to State Survey Agencies and Centers for Medicare & Medicaid Services (CMS) personnel in requesting, executing and reporting the supplemental funding.

    •Medicare Budget, Execution and Reporting: Per DHHS guidance, COVID-19 funding and expenditures must be tracked, executed and reported separately. CMS intends to implement these functions in a manner similar to existing IMPACT Act hospice funding. Cost sharing will continue according to existing State practice.

    •Medicaid Budget, Execution and Reporting: COVID-19 expenditures will be tracked and reported separately; however, funding will continue to be provided via traditional means in accordance with Medicaid rules. Cost sharing will continue according to existing State practice.

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  • May 8: CMS Interim Final Rule Requirements re: COVID-19 Reporting and the SNF QRP Go Into Effect (5/20)

    By CMS - May 04, 2020

    Note that the COVID-19 reporting and SNF QRP reporting changes both will go into effect on May 8 since the effective date is the publication date.

    Medicare and Medicaid Programs, Basic Health Program, and Exchanges: Additional Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency and Delay of Certain Reporting Requirements for the Skilled Nursing Facility Quality Reporting Program

    ACTION: Interim final rule with comment period.

    Requirement for Facilities to Report Nursing Home Residents and Staff Infections, Potential Infections, and Deaths Related to COVID-19

    We are revising § 483.80 to establish explicit reporting requirements for long-term care (LTC) facilities to report information related to COVID-19 cases among facility residents and staff. These reporting requirements are applicable on the effective date of this IFC.

    SNF QRP

    We are revising the compliance date for the SNF QRP to October 1st of the year that is at least two full fiscal years after the end of the PHE. This change is applicable on the effective date of this IFC.

     


    Requirement for Facilities to Report Nursing Home Residents and Staff Infections, Potential Infections, and Deaths Related to COVID-19

     

    We are revising § 483.80 to establish explicit reporting requirements for long-term care (LTC) facilities to report information related to COVID-19 cases among facility residents and staff. These reporting requirements are applicable on the effective date of this IFC.

    SNF QRP

    We are revising the compliance date for the SNF QRP to October 1st of the year that is at least two full fiscal years after the end of the PHE. This change is applicable on the effective date of this IFC.

     

    Requirement for Facilities to Report Nursing Home Residents and Staff Infections, Potential Infections, and Deaths Related to COVID-19

     

    We are revising § 483.80 to establish explicit reporting requirements for long-term care (LTC) facilities to report information related to COVID-19 cases among facility residents and staff. These reporting requirements are applicable on the effective date of this IFC.

    SNF QRP

    We are revising the compliance date for the SNF QRP to October 1st of the year that is at least two full fiscal years after the end of the PHE. This change is applicable on the effective date of this IFC.

     

    Requirement for Facilities to Report Nursing Home Residents and Staff Infections, Potential Infections, and Deaths Related to COVID-19

     

    We are revising § 483.80 to establish explicit reporting requirements for long-term care (LTC) facilities to report information related to COVID-19 cases among facility residents and staff. These reporting requirements are applicable on the effective date of this IFC.

    SNF QRP

    We are revising the compliance date for the SNF QRP to October 1st of the year that is at least two full fiscal years after the end of the PHE. This change is applicable on the effective date of this IFC.

     

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  • Coronavirus Commission for Safety and Quality in Nursing Homes to Focus on Identifying Best Practices, Strengthening Regulations and Enforcement (4/20)

    By CMS - April 30, 2020

    On April 30, the Centers for Medicare & Medicaid Services (CMS) announced that an independent Commission will conduct a comprehensive assessment of the nursing home response to the 2019 Novel Coronavirus (COVID-19) pandemic. The Commission will be convened and lead by a CMS contractor and will provide independent recommendations to the contractor to review and report to CMS to help inform immediate and future responses to COVID-19 in nursing homes. 

    The convening of the Commission is the next step in improving quality and safety within nursing homes. The Commission will help inform efforts to safeguard the health and quality of life of vulnerable Americans as CMS continues to battle COVID-19. The Commission will include residents, families, resident/patient advocates, leading industry experts, clinicians, medical ethicists, administrators, academicians, infection control and prevention professionals, state and local authorities, and other experts selected through a nomination process.

    It is expected to convene in May and develop recommendations on three key tasks: 

    • Putting nursing home residents first by ensuring they are protected from COVID-19 and improving the responsiveness of care delivery to meet the needs of all residents to maximize quality of life for residents.

    • Strengthen regulations to enable rapid and effective identification and mitigation of COVID-19 transmission in nursing homes; and 

    • Enhance federal and state enforcement strategies to improve compliance with infection control policies in response to COVID-19. 

    Additionally, the Commission will focus on identifying potentially innovative approaches for using existing and newly available nursing home (and other) data to enable better coordination between federal surveyors and state and local entities to address the current spread of COVID-19 within nursing homes as well as to analyze the impact of efforts to stop or contain the virus within these facilities. 

    Participants will help to identify best practices to address COVID-19, which CMS or states may incorporate into a larger regulatory framework for effective oversight to better inform federal and state officials as well as nursing homes across the country, to better achieve compliance through improved enforcement solutions, and to improve the quality of life and overall health status of nursing home residents during the pandemic. 

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  • AHRQ COVID-19 Articles: Peer Support/Crisis Communications and Helping LTC Settings Deal With the Pandemic (4/20)

    By AHRQ - April 28, 2020

    COVID-19: Peer support and crisis communication strategies to promote institutional resilience.

    Wu AW, Connors C, Everly Jr GS. Ann Intern Med. 2020

    To address the negative psychological impacts faced by healthcare workers during the COVID-19 crisis, the authors of this commentary recommend three strategic principles for healthcare institutions responding to the pandemic:

    ·  Encourage leadership to focus on resilience

    ·  Ensure that crisis communication provides both information and empowerment

    ·  Create a continuum of staff support within the organization to address a surge in mental health concerns among healthcare workers.

     

    Unprecedented solutions for extraordinary times: helping long-term care settings deal with the COVID-19 pandemic.

    Gaur S, Dumyati G, Nace DA, et al.  Infect Control Hosp Epidemiol. 2020

    This commentary discusses the provision of safe care in long-term care settings during the COVID-19 pandemic. The authors propose the following measures to ensure the safety of long-term care patients:

    ·  facilities should only accept patients with COVID-19 infections if they can provide effective airborne isolation;

    ·  patients recovering from COVID-19 need to have 2 negative tests on 2 consecutive days, as well as remain fever-free without mediation for at least 48 hours and not require ventilatory support that generates aerosols;

    ·  facilities should screen potential admissions for typical and atypical signs and symptoms of COVID-19, and;

    ·  facilities that are currently COVID-19 naïve should not accept any new admissions for whom there may be a concern for COVID-19.

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  • Infection Prevention and Control: Biphasic Outbreak of Invasive Group A Streptococcus Disease in Eldercare Facility, New Zealand (4/20)

    By CDC - April 28, 2020

    Emerging Infectious Diseases

    Volume 26, Number 5—May 2020

    Biphasic Outbreak of Invasive Group A Streptococcus Disease in Eldercare Facility, New Zealand

    Abstract

    A 3-month outbreak of invasive group A Streptococcus disease at an eldercare facility, in which 5 persons died, was biphasic. Although targeted chemoprophylaxis contained the initial outbreak, a second phase of the outbreak occurred after infection control processes ended. To retrospectively investigate the genomic epidemiology of the biphasic outbreak, we used whole-genome sequencing and multiple bioinformatics approaches. Analysis of isolates from the outbreak and isolates prospectively collected during the outbreak response indicated a single S. pyogenes emm81 clone among residents and staff members. Outbreak isolates differed from nonoutbreak emm81 isolates by harboring an integrative conjugative genomic element that contained the macrolide resistance determinant erm(TR). This study shows how retrospective high-resolution genomic investigations identified rapid spread of a closed-facilty clonal outbreak that was controlled, but not readily cleared, by infection control management procedures.

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  • COVID-19 Insights From CMS Nursing Home Calls

    By Caralyn Davis, Staff Writer - April 20, 2020
    The Centers for Medicare & Medicaid Services (CMS) holds weekly COVID-19: Nursing Home calls, bringing together insights from CMS officials, experts at the Centers for Disease Control and Prevention (CDC), and nursing home staff who have been navigating COVID-19 in their facilities. Here are highlights from the April 8 and April 15 calls.
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  • COVID-19 Notification/Reporting Requirements Addressed in CMS QSO Memo (4/20)

    By CMS - April 19, 2020

    DATE: April 19, 2020

    TO: State Survey Agency Directors

    FROM: Director Quality, Safety & Oversight Group

    SUBJECT: Upcoming Requirements for Notification of Confirmed COVID-19 (or COVID19 Persons under Investigation) Among Residents and Staff in Nursing Homes

    Memorandum Summary

    • CMS is committed to taking critical steps to ensure America’s health care facilities are prepared to respond to the 2019 Novel Coronavirus (COVID-19) Public Health Emergency (PHE).

    • Communicable Disease Reporting Requirements: To ensure appropriate tracking, response, and mitigation of COVID-19 in nursing homes, CMS is reinforcing an existing requirement that nursing homes must report communicable diseases, healthcare-associated infections, and potential outbreaks to State and Local health departments. In rulemaking that will follow, CMS is requiring facilities to report this data to the Centers for Disease Control and Prevention (CDC) in a standardized format and frequency defined by CMS and CDC. Failure to report cases of residents or staff who have confirmed COVID -19 and Persons under Investigation (PUI) could result in an enforcement action. This memorandum summarizes new requirements which will be put in place very soon.

    • Transparency: CMS will also be previewing a new requirement for facilities to notify residents’ and their representatives to keep them up to date on the conditions inside the facility, such as when new cases of COVID-19 occur.

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