ACTION: PREPARE for Respiratory Viruses (e.g., SARS-CoV-2, Influenza, RSV)
Preparation is key to mitigating the impact of respiratory viruses in long-term care facilities. A comprehensive long-term care plan toolkit for the elderly must prioritize proactive measures to safeguard residents and healthcare personnel (HCP).
Vaccination Strategies
Vaccination stands as the cornerstone of defense against respiratory viruses. For elderly individuals in long-term care, and the staff who care for them, vaccines are critical in preventing severe illness, hospitalizations, and fatalities.
- Ensure Accessible Vaccination: Provide readily available recommended vaccines for both residents and HCP. Leverage partnerships with pharmacies and public health organizations to guarantee access to all indicated vaccines.
- Promote Vaccine Confidence: Implement robust communication strategies to encourage vaccination. Utilize visual aids like graphics and posted materials. Send informative letters to families and visitors, emphasizing the importance of vaccination in protecting their loved ones and the community.
Vaccination Guide for Older Adults Infographic
Resource Allocation and Stockpiling
A proactive long-term care plan tool kit includes anticipating resource needs. Adequate supplies are crucial for preventing infection spread.
- Maintain Sufficient Supplies: Regularly assess and maintain stocks of essential resources like personal protective equipment (PPE) and alcohol-based hand sanitizer (ABHS). Resource limitations should never compromise adherence to recommended infection prevention and control (IPC) practices.
- Plan for Surge Capacity: Develop contingency plans for situations that may require increased supplies, such as outbreaks or multiple symptomatic individuals. This ensures the facility can effectively respond to increased demand without depleting critical resources.
Education, Monitoring, and Ventilation
Beyond vaccination and resource allocation, a robust long-term care plan toolkit incorporates continuous education, vigilant monitoring, and optimized ventilation strategies.
- Comprehensive Education Programs: Implement ongoing education programs for HCP, residents, and families on respiratory virus prevention. Cover topics like hand hygiene, respiratory etiquette, early symptom recognition, and the importance of staying home when sick.
- Active Symptom Monitoring: Establish systems for daily monitoring of residents and HCP for signs and symptoms of respiratory illness. Early detection is crucial for prompt isolation and preventing wider spread.
- Ventilation System Optimization: Regularly review and optimize ventilation systems to enhance air circulation and improve air quality. Explore supplemental measures to further improve air cleanliness, especially in communal areas and resident rooms.
ACTION: RESPOND to Respiratory Viral Infection Symptoms
Rapid response is paramount when a resident or HCP exhibits symptoms of a respiratory viral infection. A key component of a long-term care plan tool kit is a clear protocol for immediate action.
Preventing Transmission: Isolation and Precautions
The primary goal upon identifying a potential respiratory infection is to prevent further transmission within the facility.
- Transmission-Based Precautions for Residents: Immediately implement appropriate Transmission-Based Precautions for any symptomatic resident, based on suspected infection. This includes placing the resident in a single-person room. If a resident must leave their room for essential medical reasons, ensure they practice physical distancing and wear a facemask for source control. Maintain these precautions until the resident is no longer considered infectious.
- Enhanced PPE for HCP: Healthcare personnel entering the room of a resident with suspected respiratory viral infection, especially if SARS-CoV-2 is a concern, should strictly adhere to Standard Precautions. Utilize a NIOSH-approved® particulate respirator with N95® filters or higher, along with gown, gloves, and eye protection (goggles or face shield). PPE requirements can be adjusted once the specific pathogen is identified. Refer to Appendix A of the 2007 Guideline for Isolation Precautions for detailed PPE guidance for various respiratory viruses.
Supportive Sick Leave Policies for Healthcare Personnel
A supportive long-term care plan tool kit includes policies that encourage sick HCP to stay home, preventing presenteeism and further spread.
- Non-Punitive Sick Leave: Develop and enforce sick leave policies that are non-punitive, flexible, and consistent with public health recommendations. This encourages HCP experiencing respiratory symptoms to stay home for the recommended duration of work restriction without fear of negative repercussions.
Testing, Treatment, and Prophylaxis
Prompt testing and appropriate treatment are essential components of an effective response strategy.
- Rapid Diagnostic Testing: Establish protocols for immediate testing of anyone exhibiting respiratory illness signs or symptoms. Rapid diagnosis informs appropriate treatment and isolation measures.
- Timely Treatment and Prophylaxis: Provide recommended treatment and prophylaxis to infected and exposed residents promptly, as indicated by the specific virus and individual health status. For SARS-CoV-2, follow established treatment protocols.
Investigation and Contact Tracing
Proactive investigation is crucial to understand the scope of potential spread and implement targeted control measures.
- Investigate Potential Spread: Thoroughly investigate any identified respiratory infection case to detect potential spread among both residents and HCP. This may involve contact tracing to identify and monitor exposed individuals.
ACTION: CONTROL Respiratory Virus Spread During Outbreaks
When respiratory virus transmission is confirmed, a swift and coordinated control response is vital to prevent widespread outbreaks. This is a critical phase of the long-term care plan tool kit.
Notification and Public Health Collaboration
Immediate notification to public health authorities is a crucial first step in outbreak control.
- Notify Public Health Departments: Immediately notify the local or state public health department when respiratory viral outbreaksA are suspected or confirmed (e.g., COVID-19, influenza, other viruses). Public health departments offer valuable IPC expertise and may provide access to additional testing resources to identify the causative pathogen.
Initial Control Measures for Limited Spread
When transmission appears limited, initial interventions can focus on containment.
- Reinforce Vaccination Efforts: Re-emphasize and offer vaccination to all residents and HCP, highlighting its crucial role in outbreak control.
- Enhance Ventilation Strategies: Implement supplemental measures to improve air circulation and air cleanliness throughout the affected areas or facility-wide.
- Universal Masking Implementation: Institute universal masking for source control. This includes requiring facemasks for all HCP facility-wide and for residents when outside of their rooms or around others.
- Active Surveillance and Management: Maintain or enhance active surveillance to quickly identify new cases of respiratory viral illness. Implement robust management protocols for exposed or infected individuals, including source control and work restrictions for HCP, and consistent use of Transmission-based Precautions.
- Consider Unit-Specific Quarantine: If transmission is confined to specific units, consider limited quarantine of those units. This might involve restricting group activities or communal dining between residents from affected and unaffected units.
Additional Measures for Uncontrolled Spread
If initial interventions fail to control the outbreak, more stringent measures may be necessary, in consultation with public health experts.
- Consult Public Health for Advanced Interventions: Consult with the local or state public health department to determine and implement additional interventions tailored to the specific outbreak situation.
- Establish Cohort Units: Consider creating cohort units to group residents with confirmed infections together. Dedicate specific HCP teams to care exclusively for residents in cohort units to minimize cross-contamination and restrict HCP movement between affected and unaffected areas of the facility.
- Limit Communal Activities: Further restrict or eliminate group activities and communal dining to reduce opportunities for transmission. Consider limiting access to communal areas where residents or HCP might congregate across different units or facility-wide.
- Modify Visitation Policies: Re-evaluate and potentially modify indoor visitation policies to minimize the risk of introducing or spreading infection. Counsel visitors about potential exposure risks and, if visits proceed, recommend in-room visits with limited movement within the facility and restricted interaction with other residents.
- Restrict Admissions and Transfers: Temporarily avoid new admissions or transfers into or out of affected units or facility-wide if the outbreak is widespread, to prevent further spread within and beyond the facility.
Resources
CDC Information on Specific Respiratory Viruses
Unexplained respiratory disease outbreaks
CDC Information on Respiratory Virus Infection Prevention and Testing
Guidance and recommendations
Resources
CDC Information on Respiratory Pathogen Vaccination
Guidance and recommendations
Resources for providers
Resources for residents and families
Additional Information on Respiratory Pathogen Vaccination
Billing and payment information
Vaccine Confidence
CDC Information on Respiratory Virus Treatment
Guidance and recommendations
Resources
Additional Information on Respiratory Virus Vaccination
CDC Information for Respiratory Virus Data and Reporting
Guidance and recommendations
Resources
Health Department Information on Respiratory Virus Outbreak Response
N95 and NIOSH Approved are certification marks of the U.S. Department of Health and Human Services (HHS) registered in the United States and several international jurisdictions.
