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

    Monday, November 23, 2020 | CDC

    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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  • Upgrade Your NHSN Access to Do Required Reporting of Point-of-Care SARS-CoV-2 Testing Data? (10/20)

    Friday, October 23, 2020 | CDC

    NHSN Long-Term Care COVID-19 Module — CDC’s National Healthcare Safety Network (NHSN) added a Point of Care Laboratory Reporting Pathway within the NHSN Long-Term Care COVID-19 Module. This added capability enables CMS-certified long-term care facilities to meet the Department of Health and Human Services’ requirement to report SARS-CoV-2 point-of-care antigen test data, and other on-site COVID-19 laboratory testing data.

    The HHS guidance states: "CMS-certified long-term care facilities shall submit point-of-care SARS-CoV-2 testing data, including antigen testing data, to CDC’s National Healthcare Safety Network (NHSN). This requirement to submit data to CDC’s NHSN applies only to CMS-certified long-term care facilities. Test data submitted to NHSN will be reported to appropriate state and local health departments using standard electronic laboratory messages. Other types of LTC facilities may voluntarily report testing data in NHSN for self-tracking or to fulfill state or local reporting requirements, if any."

    The new NHSN pathway creates a single, standardized reporting system:

    ·  that all ~15,400 nursing homes already use for other mandatory COVID-19 reporting;

    ·  has the capability to share data with state and local health departments;

    ·  has the ability to share data with HHS and CMS; and

    ·  avoids the creation of a patchwork of different jurisdictional reporting systems by state health departments.

    In order to utilize the new pathway to fulfill reporting requirements, nursing homes and other long-term care facilities that are NHSN users will need to upgrade their NHSN Secure Access Management Service (SAMS) from Level 1 to Level 3.  CDC is working closely with facilities to assist them in this process. An email invitation from CDC to perform this upgrade will be sent to users. Alternatively, facilities can email nhsn@cdc.gov with the subject line “Enhancing Data Security” to begin upgrading their SAMS access to use this Pathway.

    Guidance for SARS-CoV-2 Point-of-Care Testing — Point-of-care (POC) tests, such as some rapid tests for diagnosing an infectious disease, provide results within minutes of the test being administered, allowing for rapid decisions about patient care. POC tests can also extend testing to communities and populations that cannot readily access care. This page provides detailed information on the following:

    ·  Overview of POC testing

    ·  How to obtain a Clinical Laboratory Improvement Amendments (CLIA) certificate

    ·  How to safely perform POC specimen collection, handling, and testing for COVID-19

    ·  How to comply with result reporting requirements

    To learn more, please visit: Guidance for SARS-CoV-2 Point-of-Care Testing

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  • Asymptomatic and Presymptomatic SARS-COV-2 Infection Rates in a Multistate Sample of SNFs (10/20)

    Thursday, October 22, 2020 | Journal of the American Medical Association

    COVID-19 study: Asymptomatic and Presymptomatic Severe Acute Respiratory Syndrome Coronavirus 2 Infection Rates in a Multistate Sample of Skilled Nursing Facilities

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  • National Healthcare Safety Network Long-term Care Facility COVID-19 Reporting Module Website (10/20)

    Thursday, October 15, 2020 | CDC

    CDC’s NHSN provides healthcare facilities, such as long-term care facilities (LTCFs), 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 national healthcare-associated infection goals.

    The NHSN Long-term Care Facility Component is supporting the nation’s COVID-19 response through the COVID-19 Module for LTCFs. 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

    Data submitted into the Module pathways enables an assessment of the impact of COVID-19 through facility reported information, including: 1) counts of residents and facility personnel with newly suspected and laboratory positive COVID-19; 2) death counts among residents and facility personnel with suspected and laboratory positive COVID-19; 3) staffing shortages; 4) availability of personal protective equipment (PPE) and supplies; and 5) ventilator capacity and supplies for facilities with ventilator dependent units.

    In addition to the reporting pathways, the Point-of-Care (POC) Test Reporting Tool has been added to enable LTCFs to enter POC SARS-CoV-2 test results into the NHSN application.  NHSN will route the POC laboratory test data to the public health agency at the local or state level that has jurisdictional authority and responsibility to receive those data.  Health agencies, in turn, will use the data to fulfill their public health functions, which include reporting to the US Department of Health and Human Services, where the data will be used in the COVID-19 response. Participation in this pathway requires users to have secure access through Secure Access Management Services (SAMS), which includes having a SAMS grid card.

    LTCF data submission options include manual entry and/or CSV file submitted by individual facilities or bulk CSV file upload for multiple facilities. Note: CSV file submission is not currently available for the Point-of-Care (POC) Test Reporting Tool.


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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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  • CMS Updates COVID-19 Testing Methodology for Nursing Homes (9/20)

    Tuesday, September 29, 2020 | CMS

    Note: The updated methodology is inside the updated spreadsheet for weekly county positivity rates: Rates of county positivity are posted here

    The Centers for Medicare & Medicaid Services (CMS) announced an update to the methodology the agency employs to determine the rate of coronavirus disease 2019 (COVID-19) positivity in counties across the country. Counties with 20 or fewer tests over 14 days will now move to “green” in the color-coded system of assessing COVID-19 community prevalence. Counties with both fewer than 500 tests and fewer than 2,000 tests per 100,000 residents, and greater than 10 percent positivity over 14 days – which would have been “red” under the previous methodology – will move to “yellow.” This information is critical to nursing homes, which are required to test their staff for COVID-19 at a frequency based on the positivity rate of their respective counties.

    Under guidance CMS issued on August 26, 2020, nursing homes must test staff at a frequency of once monthly if the facility’s county positivity rate is less than five percent. Staff testing frequency increases to once weekly if the county positivity rate is between five and 10 percent. Finally, testing frequency increases to twice weekly if the county positivity rate exceeds 10 percent.

    CMS heard concerns from some governors of rural states that the frequency guidelines did not work well for some rural areas. They were concerned that some rural counties had seemingly high comparative positivity rates as a result of low amounts of testing, rather than actual positivity in the community. This resulted in a significant burden for nursing homes being required to conduct staff testing at a higher frequency than necessary. In response to these concerns, the Trump Administration acted swiftly and decisively, and implemented the change to the positivity rate calculation in order to accommodate rural counties.  The new, resulting methodology reduces burden while still requiring facilities to conduct testing to at a frequency that can detect COVID-19 early to keep nursing home residents safe.

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  • Two CDC Studies Examine COVID-19 Testing in SNFs/NFs (9/20)

    Thursday, September 17, 2020 | CDC

    Serial Testing for SARS-CoV-2 and Virus Whole Genome Sequencing Inform Infection Risk at Two Skilled Nursing Facilities with COVID-19 Outbreaks — Minnesota, April–June 2020

    Summary

    What is already known about this topic?

    Facility-wide, serial testing in skilled nursing facilities (SNFs) can identify asymptomatic SARS-CoV-2 infections among health care personnel (HCP) and residents to inform mitigation efforts.

    What is added by this report?

    Serial facility-wide testing at two Minnesota SNFs identified COVID-19 cases among 64% of residents and 33% of HCP. Genetic sequencing found facility-specific clustering of viral genomes from HCP and residents’ specimens, suggesting intrafacility transmission.

    What are the implications for public health practice?

    HCP working in SNFs are at risk for infection during COVID-19 outbreaks. To protect residents and prevent SARS-CoV-2 infection among HCP, SNFs need enhanced infection prevention and control practices, assured availability of personal protective equipment, improved HCP testing participation, flexible medical leave, and timely result reporting.

     

    Preventing COVID-19 Outbreaks in Long-term Care Facilities Through Preemptive Testing of Residents and Staff Members — Fulton County, Georgia, March–May 2020

    Summary

    What is already known about this topic?

    Residents of long-term care facilities (LTCFs) are at risk for severe COVID-19. Facility-wide testing, even in the absence of a reported COVID-19 case, can identify asymptomatic and presymptomatic infection in LTCFs.

    What is added by this report?

    LTCFs in which testing was conducted after a confirmed case of COVID-19 were found to have significantly higher proportions of infected residents and staff members at initial testing and after 4 weeks of follow-up compared with those testing as a preventive measure. The majority of LTCFs testing as a preventive measure identified an infection, although initial prevalence was significantly lower and fewer cases occurred during follow-up.

    What are the implications for public health practice?

    Proactive testing of LTCF residents and staff members might prevent large COVID-19 outbreaks in LTCFs through early identification and timely infection prevention and control response.

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  • COVID-19 Testing and Reporting Requirements: Summary Slide Deck (9/20)

    Thursday, September 10, 2020 | CMS

    CMS slide deck summarizing resident and staff testing  and reporting requirements, considerations for using and interpreting antigen tests, and educational resources and training available to nursing homes.

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  • CMS-CDC Fundamentals of COVID-19 Prevention for Nursing Home Management: QIO National Nursing Home Training Series (8/20)

    Tuesday, August 18, 2020 | CMS/CDC

    Starting on August 20, using a pre-recorded, self-paced format, the new CMS-CDC Fundamentals of COVID-19 Prevention for Nursing Home Management training series will include 13 topics that nursing homes must know to manage the COVID-19 pandemic. These trainings will be housed on QIOProgram.org for 24/7 access.

    New, pre-recorded trainings will be released every Thursday at 4:00 p.m. EST through September 2020. CMS and CDC will have subject matter experts available on bi-weekly Q&A sessions through early January 2021 to answer questions you may have about the trainings.

    Critical Topics

    Establishing an Infection Prevention Program in a Nursing Home, with an emphasis on COVID-19
    Is your Nursing Home ready to handle the demands of the COVID-19 Pandemic? Assessing Readiness: Advice from the CDC 
    COVID-19 surveillance to enable early detection and response to outbreaks. Includes NHSN mandatory data collection
    COVID-19 Testing - coming soon
    Cohorting Strategies
    Cleaning Environmental Surfaces and Shared Equipment 
    Establishing a Dedicated COVID-19 Care Center - coming soon
    Hand Hygiene and Personal Protective Equipment (PPE) Strategies for COVID-19 Care: Supply, Use, Re-use, Removal, and Disposal
    Accepting new patients during an active pandemic: considerations of both transfers from hospitals, and admissions from the community - coming soon
    Telehealth in Nursing Homes
    Transparency: Resident and Family Notification. Department of Health and other Notifications
    Clinical Care/‚ÄčManaging COVID positive residents in the Nursing Home
    Managing Staffing Challenges, Including Employee Health Considerations

    Looking for which trainings you need? Take the Training Fundamentals Self-Assessment.

    What isn’t Changing: Access to certificates of participation are still available for those who complete Fundamentals trainings and those who have participated in the live training series. 

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  • FAQs About COVID-19 Testing in SNFs/NFs (8/20)

    Monday, August 10, 2020 | CMS

    Frequently Asked Questions: COVID-19 Testing at Skilled Nursing Facilities/ Nursing Homes includes 27 FAQs:

    1. Who will receive the testing platforms and U.S. Food and Drug Administration (FDA)- authorized antigen diagnostic tests?

    2. How is distribution of the testing platforms and FDA-authorized antigen diagnostic tests being determined? Will these devices be sent directly to the nursing homes or to states for distribution? 

    3. When will the testing platforms and authorized point-of-care tests be distributed?

    4. How many COVID-19 test kits will nursing homes receive?

    5. Who will provide training to nursing home staff? In what format will the training be provided in?

    6. How were nursing homes prioritized to receive a testing platform and FDA-authorized antigen diagnostic tests?

    7. Will HHS be providing more tests after the initial shipment?

    8. What safety precautions are required when performing these tests?

    9. Will every nursing home receive a point-of-care instrument and associated tests? 

    10. Which nursing homes will receive instruments and tests in the first wave of shipments?

    11. When will my nursing home receive the shipment of testing platforms and FDAauthorized antigen diagnostic tests?

    12. How will states be made aware that nursing homes within their states will receive instruments and supplies?

    13. What are antigen tests? Is it required to retest negative results with a PCR test?

    14. How many tests can be conducted with the Quidel Sofia 2 Instrument and the BD Veritor™ Plus System testing platforms?

    15. Why is the federal government sending antigen testing supplies to nursing homes if they cannot be used to rule out SARS-CoV-2 infection and should not be used as the sole basis for treatment?

    16. Are nursing homes required to report results of any COVID-19 tests?

    17. Can nursing homes keep the testing platforms? 

    18. How should facilities handle indeterminate results?

    19. Do facilities need a provider order to conduct the test?

    20. How should the materials be stored when they arrive?

    21. Does a Skilled Nursing Facility/ Nursing Facilities need a CLIA (Clinical Laboratory Improvement Amendments of 1988) Certificate of Waiver in order to perform testing of specimens for COVID-19?

    22. I understand that HHS will be distributing tests and test systems to Skilled Nursing Facilities/ Nursing Facilities. What type of CLIA certificate would my facility need in order to perform this testing?

    23. How do I apply for a CLIA Certificate of Waiver so that my Skilled Nursing Facility/ Nursing Facility can perform COVID-19 testing?

    24. If my Skilled Nursing Facility/ Nursing Facility already holds a CLIA Certificate of Waiver, can we begin performing COVID-19 testing?

    25. If my Skilled Nursing Facility/ Nursing Facility already holds a CLIA Certificate of Waiver, am I required to update my test menu with CMS?

    26. How does my Skilled Nursing Facility/ Nursing Facility obtain the instrument, test kits and disposables?

    27. My Skilled Nursing Facility/ Nursing Facility is located in a CLIA Exempt State (Washington or New York). Will we be able to get one of the new test systems? 

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