• CMS Podcast: Nursing Home Series for Front Line Clinicians and Staff (11/20)

    Thursday, November 19, 2020 | CMS

    The Centers for Medicare & Medicaid Services (CMS) is releasing the first episode in a series of short podcasts for frontline nursing home staff “CMS Beyond the Policy”.

    This edition is titled “Nursing Home Series for Front Line Clinicians and Staff.” Dr. Shari Ling, Deputy Chief Medical Office for The Centers for Medicare and Medicaid Services and geriatrician is joined by David Wright, Director of the Quality Safety & Oversight Group to discuss training and infection control practices in nursing homes to help combat the spread of coronavirus disease 2019 (COVID-19).

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  • CMS Urgent Call to Action: Staff, Managers Should Complete QSEP Nursing Home COVID-19 Training (11/20)

    Tuesday, November 17, 2020 | CMS

    Agency thanks nursing homes whose staff have completed free CMS training, but urges remaining homes to take advantage of this resource

    The Centers for Medicare & Medicaid Services (CMS) is publicly recognizing the 1,092 nursing homes at which 50% or more of their staff have completed CMS training designed to help staff combat the spread of coronavirus disease 2019 (COVID-19) in nursing homes. CMS applauds these facilities for taking this critical step to equip their staff with the latest information regarding infection control, vaccine distribution, and other topics.

    There are 125,506 individuals from 7,313 nursing homes who have completed the training. This represents approximately 12.5% of the approximately one million nursing home staff in the country. With today’s announcement, CMS is calling on nursing homes to take action, urging them to require their staff to take this free training, as part of the Trump Administration’s continued efforts to keep nursing home residents safe.

    “We’ve provided nursing homes with $20 billion in federal funding, millions of pieces of PPE, free testing machines and supplies, and significant technical assistance and on-the-ground support,” said CMS Administrator Seema Verma. “Ultimately, the ownership and management of every nursing must take it on themselves to ensure their staff is fully equipped to keep residents safe. With coronavirus cases increasing across the country and infection control identified as a major issue, we encourage all nursing homes to take advantage of this no-cost opportunity to train their staff.”

    The training includes multiple modules, with emphases on topics such as infection control, screening and surveillance, personal protective equipment (PPE) usage, disinfection of the nursing home, cohorting and caring for individuals with dementia during a pandemic. CMS developed this training in consultation with the Centers for Disease Control and Prevention (CDC) and expert stakeholders, and announced the training on August 25, 2020. For anyone interested, the training is free to access on a public CMS website; instructions on how to create an account and take the training are available at qsep.cms.gov/welcome.aspx.

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  • Vaccinate Your Staff: CDC LTC Toolkit for Staff Influenza (Flu) Vaccination (11/20)

    Saturday, November 14, 2020 | CDC
    Post-acute and Long-term Care Facility Toolkit: Influenza Vaccination among Healthcare Personnel: Increasing Influenza Vaccination among Health Care Personnel in Long-term Care Settings

     

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  • CDC Study Shows How Community Transmission Can Impact Nursing Homes Miles Away (11/20)

    Tuesday, November 10, 2020 | CDC

    Multiple COVID-19 Outbreaks Linked to a Wedding Reception in Rural Maine — August 7–September 14, 2020

    Weekly / November 13, 2020 / 69(45);1686–1690

    Parag Mahale, MBBS, PhD1,2; Craig Rothfuss, MPA, MPH1,3; Sarah Bly1,3; Megan Kelley1,3; Siiri Bennett, MD1; Sara L. Huston, PhD1,3; Sara Robinson, MPH1 (View author affiliations)

    View suggested citation

    Summary

    What is already known about this topic?

    Large gatherings pose a high risk for SARS-CoV-2 transmission.

    What is added by this report?

    A wedding reception with 55 persons in a rural Maine town led to COVID-19 outbreaks in the local community, as well as at a long-term care facility and a correctional facility in other counties. Overall, 177 COVID-19 cases were linked to the event, including seven hospitalizations and seven deaths (four in hospitalized persons). Investigation revealed noncompliance with CDC’s recommended mitigation measures.

    What are the implications for public health practice?

    To mitigate transmission, persons should avoid large gatherings, practice physical distancing, wear masks, stay home when ill, and self-quarantine after exposure to a person with confirmed SARS-CoV-2 infection.

     

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  • OSHA Respiratory Protection Guidance for Nursing Homes (11/20)

    Tuesday, November 3, 2020 | Occupational Safety and Health Administration

    Respiratory Protection Guidance for the Employers of Those Working in Nursing Homes, Assisted Living, and Other Long-Term Care Facilities During the COVID-19 Pandemic

    This guidance is designed specifically for nursing homes, assisted living, and other long-term care facilities (LTCFs) (e.g., skilled nursing facilities, inpatient hospice, convalescent homes, and group homes with nursing care). While this guidance focuses on protecting workers from occupational exposure to SARS-CoV-2 (the virus that causes COVID-19 disease) by the use of respirators, primary reliance on engineering and administrative controls for controlling exposure is consistent with good industrial hygiene practice and with OSHA’s traditional adherence to a “hierarchy of controls.”

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  • Cybersecurity Alert: Ransomware Activity Targeting the Healthcare and Public Health Sector (10/20)

    Friday, October 30, 2020 | ASPR TRACIE
    The U.S. Department of Health and Human Services (HHS), the Cybersecurity and Infrastructure Security Agency (CISA), and the Federal Bureau of Investigation (FBI) have developed a cybersecurity alert related to an increased and imminent cybercrime threat to U.S. hospitals and healthcare providers: "Alert (AA20-302A) Ransomware Activity Targeting the Healthcare and Public Health Sector." This advisory describes the tactics, techniques, and procedures (TTPs) used by cybercriminals against targets in the Healthcare and Public Health Sector (HPH) to infect systems with Ryuk ransomware for financial gain. CISA, FBI, and HHS are sharing this information to provide warning to healthcare providers to ensure that they take timely and reasonable precautions to protect their networks from these threats.
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  • SARS-CoV-2 Exposure and Infection Among Health Care Personnel: LTC Staff More Likely to Work With Symptoms (10/20)

    Wednesday, October 28, 2020 | CDC

    SARS-CoV-2 Exposure and Infection Among Health Care Personnel — Minnesota, March 6–July 11, 2020

    Weekly / October 30, 2020 / 69(43);1605–1610

    Summary

    What is already known about this topic?

    Health care personnel (HCP) are at increased risk for COVID-19 from workplace exposures.

    What is added by this report?

    Among 21,406 Minnesota SARS-CoV-2 HCP exposures, 5,374 (25%) were higher-risk (within 6 feet, ≥15 minutes, or during an aerosol-generating procedure); exposures involved patient care (66%) and nonpatient contacts (34%). Compared with HCP working in acute care settings, those working in congregate living and long-term care more often worked while symptomatic and received positive SARS-CoV-2 test results.

    What are the implications for public health practice?

    HCP should recognize potential exposures unrelated to patient care and use prevention measures, including masks. HCP in congregate living and long-term care settings experience considerable risk and pose a transmission risk to residents. Improved access to personal protective equipment, flexible medical leave, and testing is needed.

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  • AHRQ Establishes National Nursing Home COVID Action Network, Seeks Participants (9/20)

    Tuesday, September 29, 2020 | AHRQ

    Press Release Date: September 29, 2020

    The Agency for Healthcare Research and Quality (AHRQ) is partnering with the University of New Mexico’s ECHO Institute in Albuquerque and the Institute for Healthcare Improvement (IHI) in Boston to establish a National Nursing Home COVID Action Network. The network will provide free training and mentorship to nursing homes across the country to increase the implementation of evidence-based infection prevention and safety practices to protect residents and staff.

    Nursing home residents are especially vulnerable to SARS-COV-2 (COVID-19) due to their age, their underlying frailty, and their communal living conditions. And nursing home staff who care for them are among the most needed and most at-risk essential workers. It is estimated that almost 56,000 nursing home residents and staff have died from COVID-19, representing more than one-quarter of the nation’s known COVID-19 deaths.

    "Protecting vulnerable older Americans in nursing homes is a central part of our fight against COVID-19, and we’ve learned that improving infection control in many nursing homes is not a matter of will but of skill," said HHS Secretary Alex Azar. "AHRQ is deploying its unique expertise in partnership with Project ECHO and IHI to help nursing homes protect both their residents and staff from the virus, slowing the spread and saving lives."

    "Expanding the use of proven safety practices will directly benefit nursing home residents and staff members and help save lives," said AHRQ Director Gopal Khanna, M.B.A. "AHRQ has a proven track record of producing science and research to address critical needs such as responding to COVID-19 and achieving 21st century care for all Americans. We are pleased to be working with the ECHO Institute and IHI on this new initiative."

    The new network is being created under an AHRQ contract worth up to $237 million that is part of the nearly $5 billion Provider Relief Fund authorized earlier this year under the Coronavirus Aid, Relief, and Economic Security (CARES) Act. While $2.5 billion has already been distributed to help fund testing, personal protective equipment, and other supplies, another $2 billion is available for Medicare and Medicaid-certified nursing homes that show improvement in infection control.

    The ECHO Institute is recruiting academic medical centers and large health centers across the country to serve as training centers for local nursing homes. Over 15,000 nursing homes that are certified to participate in the Medicare and Medicaid programs will be able to participate in a 16-week training program using a standardized curriculum developed by the IHI. Nursing homes that actively participate are eligible to receive $6,000 in compensation to cover staff training time.

    While the curriculum will continue to be refined as new evidence emerges and the pandemic evolves, topics to be covered in the early weeks include:

    • Best Practices in the Use of Personal Protective Equipment for COVID-19.
    • Making the Environment Safe during COVID-19 through Infection Control Practices.
    • Minimizing the Spread of COVID-19.
    • COVID-19 Testing.
    • Clinical Management of Asymptomatic and Mild Cases of COVID-19.
    • Managing Social Isolation during COVID.

    Weekly virtual training sessions will be facilitated by small multidisciplinary teams of subject matter and quality improvement experts. Sessions will combine short lectures that provide immediately usable best practices with case-based group learning. Between sessions, a robust community of practice will foster peer-to-peer learning supported by additional expert consultation.

    "Collaborative education and shared learning is critical for our nonprofit nursing home members on the front line of this pandemic, under often challenging conditions," said Katie Smith Sloan, president and CEO of LeadingAge. "Access to mentors, local experts, community peers, and resources, with a focus on continuous improvement, will go a long way to help mitigate the virus’ spread and ensure the health and safety of older adults."

    Sanjeev Arora, M.D., Project ECHO’s director and founder, said he looks forward to leading the initiative in partnership with AHRQ. "At a time when the dissemination of best practices in health care is more critical than ever, we are honored to help address this urgent need for nursing homes," he said.

    Project ECHO (Extension for Community Healthcare Outcomes) was established to provide training and telementoring for health care professionals and staff across the nation and around the world. It includes over 250 training partners across the United States. AHRQ funded the initial establishment and evaluation of Project ECHO beginning in 2004. The new network’s training program will use the evidence-based process pioneered by Project ECHO and referred to as the ECHO Model, which is an interactive, case-based approach based on adult learning principles.

    "The ECHO model is a proven approach that brings experts and providers together to learn and solve clinical and operational challenges," said Mark Parkinson, President and CEO for the American Health Care Association/National Center for Assisted Living. "We strongly encourage providers to participate in the COVID Action Network to get access to experts and learn the latest best practices to prevent the spread of COVID-19."

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  • World Health Organization Healthcare Worker Safety Charter (9/20)

    Thursday, September 17, 2020 | WHO

    Keep health workers safe to keep patients safe: WHO

    17 September 2020 | GENEVA – The World Health Organization (WHO) is calling on governments and health care leaders to address persistent threats to the health and safety of health workers and patients.

    “The COVID-19 pandemic has reminded all of us of the vital role health workers play to relieve suffering and safe lives,“ said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “No country, hospital or clinic can keep its patients safe unless it keeps its health workers safe. WHO’s Health Worker Safety Charter is a step towards ensuring that health workers have the safe working the conditions, the training, the pay and the respect they deserve.“

    The pandemic has also highlighted the extent to which protecting health workers is key to ensuring a functioning health system and a functioning society.

    The Charter, released today for World Patient Safety Day, calls on governments and those running health services at local levels to take five actions to better protect health workers. These include steps to protect health workers from violence; to improve their mental health; to protect them from physical and biological hazards; to advance national programmes for health worker safety; and to connect health worker safety policies to existing patient safety policies.

    Mounting reports of infections, illness and attacks among health workers fighting COVID-19

    COVID-19 has exposed health workers and their families to unprecedented levels of risk. Although not representative, data from many countries across WHO regions indicate that COVID-19 infections among health workers are far greater than those in the general population.

    While health workers represent less than 3% of the population in the large majority of countries and less than 2% in almost all low- and middle-income countries, around 14% of COVID-19 cases reported to WHO are among health workers. In some countries, the proportion can be as high as 35%.  However, data availability and quality are limited, and it is not possible to establish whether health workers were infected in the work place or in community settings. Thousands of health workers infected with COVID-19 have lost their lives worldwide.

    In addition to physical risks, the pandemic has placed extraordinary levels of psychological stress on health workers exposed to high-demand settings for long hours, living in constant fear of disease exposure while separated from family and facing social stigmatization. Before COVID-19 hit, medical professionals were already at higher risk of suicide in all parts of the world. A recent review of health care professionals found one in four reported depression and anxiety, and one in three suffered insomnia during COVID-19[1].  WHO recently highlighted an alarming rise in reports of verbal harassment, discrimination and physical violence among health workers in the wake of COVID-19.

    5 steps to improve health worker safety and patient safety

    On World Patient Safety Day, WHO reminds governments that they have a legal and moral responsibility to ensure the health, safety and wellbeing of health workers. The Organization’s health worker charter calls on all Member States and relevant stakeholders to take steps to:

    1. Establish synergies between health worker safety and patient safety policies and strategies

    ·         Develop linkages between occupational health and safety, patient safety, quality improvement, and infection prevention and control programmes.

    ·         Include health and safety skills in personal and patient safety into education and training programmes for health workers at all levels.

    ·         Incorporate requirements for health worker and patient safety in health care licensing and accreditation standards.

    ·         Integrate staff safety and patient safety incident reporting and learning systems.

    ·         Develop integrated metrics of patient safety, health worker safety and quality of care indicators, and integrate with health information system.  

    2. Develop and implement national programmes for occupational health and safety of health workers

    ·         Develop and implement national programmes for occupational health for health workers in line with national occupational health and safety policies.

    ·         Review and upgrade, where necessary, national regulations and laws for occupational health and safety to ensure that all health workers have regulatory protection of their health and safety at work.

    ·         Appoint responsible officers with authority for occupational health and safety for health workers at both the national and facility levels.

    ·         Develop standards, guidelines, and codes of practice on occupational health and safety.

    ·         Strengthen intersectoral collaboration on health worker and patient safety, with appropriate worker and management representation, including gender, diversity and all occupational groups.

    3. Protect health workers from violence in the workplace

    ·         Adopt and implement in accordance with national law, relevant policies and mechanisms to prevent and eliminate violence in the health sector.

    ·         Promote a culture of zero tolerance to violence against health workers

    ·         Review labour laws and other legislation, and where appropriate the introduction of specific legislation, to prevent violence against health workers.

    ·         Ensure that policies and regulations are implemented effectively to prevent violence and protect health workers.

    ·         Establish relevant implementation mechanisms, such ombudspersons and helplines to enable free and confidential reporting and support for any health worker facing violence.

    4. Improve mental health and psychological well-being

    ·         Establish policies to ensure appropriate and fair duration of deployments, working hours, rest break and minimizing the administrative burden on health workers.

    ·         Define and maintain appropriate safe staffing levels within health care facilities.

    ·         Provide indemnity and insurance coverage for work-related risk, especially those working in high-risk areas.

    ·         Establish a ‘blame-free’ and just working culture through open communication, including legal and administrative protection from punitive action on reporting adverse safety events.

    ·         Provide access to mental well-being and social support services for health workers, including advice on work-life balance and risk assessment and mitigation.

    5. Protect health workers from physical and biological hazards

    ·         Ensure the implementation of minimum patient safety, infection prevention and control, and occupational safety standards in all health care facilities across the health system.

    ·         Ensure availability of personal protective equipment (PPE) at all times, as relevant to the roles and tasks performed, in adequate quantity and appropriate fit and of acceptable quality. Ensure an adequate, locally held, buffer stock of PPE. Ensure adequate training on the appropriate use of PPE and safety precautions.

    ·         Ensure adequate environmental services such as water, sanitation and hygiene, disinfection and adequate ventilation at all health care facilities.

    ·         Ensure vaccination of all health workers at risk against all vaccine-preventable infections, including Hepatitis B and seasonal influenza, in accordance with the national immunization policy, and in the context of emergency response, priority access for health workers to newly licenced and available vaccines.

    ·         Provide adequate resources to prevent health workers from injuries, and harmful exposure to chemicals and radiations; provide functioning and ergonomically designed equipment and work stations to minimize musculoskeletal injuries and falls.

    In addition to the Health Worker Safety Charter, WHO has also outlined specific World Patient Safety Day 2020 Goals for health care leaders to invest in, measure, and improve health worker safety over the next year. The goals are intended for health care facilities to address five areas:  preventing sharps injuries; reducing work-related stress and burnout; improving the use of personal protective equipment; promoting zero tolerance to violence against health workers; and analyzing serious safety related incidents. 

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  • Independent Nursing Home COVID-19 Commission Findings (9/20)

    Wednesday, September 16, 2020 | CMS
    The Centers for Medicare & Medicaid Services (CMS) received the final report from the independent Coronavirus Commission for Safety and Quality in Nursing Homes (Commission), which was facilitated by MITRE.  CMS also released an overview of the robust public health actions the agency has taken to date to combat the spread of the coronavirus disease 2019 (COVID-19) in nursing homes. The Commission’s findings align with the actions the Trump Administration and CMS have taken to contain the spread of the virus and to safeguard nursing home residents from the ongoing threat of the COVID-19 pandemic. Today’s announcement delivers on the Administration’s commitments to keeping nursing home residents safe and to transparency for the American people in the face of this unprecedented pandemic.

    Nursing homes and other shared or congregate living facilities have been severely affected by COVID-19, as these facilities often house older individuals who suffer from multiple medical conditions, making them particularly susceptible to complications from the virus. To help CMS inform immediate and future actions as well as identify opportunities for improvement, the Commission was created to conduct an independent review and comprehensive assessments of confronting COVID-19. The Commission’s report contains best practices that emphasize and reinforce CMS strategies and initiatives to ensure nursing home residents are protected from COVID-19.

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