This toolkit is designed to assist infection preventionists and leadership in long-term care facilities, particularly nursing homes, in proactively preparing for and effectively responding to respiratory viral infections. It provides a comprehensive framework and resources to manage residents or healthcare personnel (HCP) exhibiting signs and symptoms of respiratory viral infections. While specifically tailored for nursing homes, the principles and resources within this Long Term Care Tool Kit Example can be adapted for broader application across various long-term care settings.
ACTION: PREPARE for Respiratory Viruses (e.g., SARS-CoV-2, Influenza, RSV)
Proactive preparation is the cornerstone of mitigating the impact of respiratory viruses in long-term care facilities. This section of the long term care tool kit example outlines key preparatory actions.
Vaccination: A Primary Defense
Vaccination stands as the most effective measure to prevent severe illness from respiratory viruses.
- Ensure comprehensive vaccination: Offer and administer recommended vaccines to both residents and HCP.
- Promote vaccination uptake: Actively disseminate information and encourage vaccination among families and visitors using resources like visual guides, informational posters, and personalized letters.
- Highlight benefits: Emphasize that vaccination significantly reduces the risk of severe illness, hospitalization, and mortality associated with respiratory viruses.
- Collaborate for access: Partner with pharmacies and public health agencies to guarantee seamless access to all indicated vaccines for both residents and healthcare staff.
Alt text: Infographic promoting vaccination for older adults against respiratory viruses, part of a long term care tool kit example.
Resource Allocation: Ensuring Adequate Supplies
Adequate resources are critical for consistent adherence to infection prevention protocols.
- Prevent resource shortages: Guarantee that limitations in resources, such as personal protective equipment (PPE) and alcohol-based hand sanitizer (ABHS), do not impede HCP from consistently following recommended infection prevention and control (IPC) practices.
- Plan for surge capacity: Develop contingency plans for situations involving multiple symptomatic individuals, anticipating potential surges in demand for supplies.
Monitor and Mask, Educate, Ventilate, Test and Treat: (These sections are intentionally kept concise as per the original article structure, but can be expanded if needed for further detail)
- Monitor and Mask: Implement symptom monitoring protocols for early detection and encourage mask usage as appropriate.
- Educate: Conduct regular educational sessions for staff, residents, and visitors on respiratory virus prevention and control measures.
- Ventilate: Optimize ventilation systems and explore supplemental measures to enhance air circulation and cleanliness within the facility.
- Test and Treat: Establish protocols for rapid testing and ensure access to recommended treatments and prophylactic medications.
ACTION: RESPOND to Signs and Symptoms of Respiratory Viral Infection
Prompt and decisive action is crucial when a resident or HCP exhibits symptoms of a respiratory viral infection. This section of the long term care tool kit example guides the response process.
Upon identifying an acute respiratory infection, immediate steps are necessary to prevent further spread within the facility. While specific treatments, prophylaxis, and isolation durations may vary based on the identified pathogen, core IPC strategies remain consistent across respiratory viruses. These include isolating the symptomatic individual in a single-person room, implementing source control with facemasks, and practicing physical distancing.
Preventing Spread: Implementing Transmission-Based Precautions
- For Residents: Apply appropriate Transmission-Based Precautions based on the suspected cause of infection.
- Room confinement: Residents under Transmission-Based Precautions should primarily remain in their rooms, leaving only for essential medical reasons.
- Safe transport: If room departure is necessary, ensure they practice physical distancing and wear a facemask for source control.
- Timely discontinuation: Remove residents from Transmission-Based Precautions as soon as they are no longer considered infectious.
- For Healthcare Personnel: Protect HCP with appropriate PPE.
- Enhanced PPE for unknown infections: HCP entering the room of a resident with symptoms suggestive of SARS-CoV-2 or another unknown respiratory viral infection should adhere to Standard Precautions and utilize a NIOSH-approved® N95® respirator or higher, gown, gloves, and eye protection (goggles or face shield).
- PPE adjustment: PPE protocols can be refined once the specific cause of infection is identified, referencing Appendix A of the 2007 Guideline for Isolation Precautions for detailed PPE recommendations for various respiratory viruses.
Alt text: Example of healthcare personnel using appropriate Personal Protective Equipment (PPE) as part of respiratory virus infection control, in a long term care tool kit example.
- Sick Leave Policies for HCP: Implement supportive sick leave policies.
- Non-punitive and flexible policies: Develop sick leave policies that are non-punitive, flexible, and aligned with public health guidance.
- Discourage presenteeism: These policies should discourage presenteeism (coming to work while sick) and enable HCP with respiratory infections to stay home for the recommended duration of work restriction.
Testing, Treatment, and Prophylaxis: Rapid Identification and Intervention
- Universal Testing: Test all individuals (residents and HCP) exhibiting respiratory illness signs or symptoms to promptly identify the causative pathogen.
- Treatment and Prophylaxis: Provide recommended treatment and prophylaxis to infected and exposed residents as clinically indicated and according to current guidelines.
- SARS-CoV-2 specific guidance: For confirmed SARS-CoV-2 infection, adhere to specific treatment and prophylaxis protocols.
Investigation: Detecting Potential Spread
- Investigate for potential respiratory virus transmission among both residents and HCP to understand the scope of the situation and implement targeted control measures.
ACTION: CONTROL Respiratory Virus Spread When Transmission is Identified
Aggressive control measures are vital when respiratory virus transmission is confirmed within the long-term care facility. This section of the long term care tool kit example outlines steps to manage outbreaks.
Notification and Consultation:
- Notify public health authorities: Immediately notify the local or state public health department when respiratory viral outbreaksA are suspected or confirmed. This includes outbreaks of COVID-19, influenza, and other respiratory viruses.
- Leverage public health expertise: Recognize that health departments possess valuable IPC expertise and may offer access to additional testing resources for identifying the specific viral etiology.
Implementing Control Measures:
In addition to the previously mentioned actions, consider the following interventions when transmission is identified. When implementing measures that restrict residents (e.g., quarantine, activity limitations), carefully weigh the risks and benefits to resident well-being and establish clear de-escalation plans for these time-limited strategies.
Initial Measures for Limited Spread:
- Reinforce Vaccination: Re-emphasize and facilitate vaccination efforts within the facility.
- Enhance Ventilation: Consider supplemental ventilation measures to improve air quality.
- Universal Masking: Implement universal masking for source control on affected units or facility-wide, for both residents (when around others outside their rooms) and HCP within the facility.
- Active Surveillance: Maintain active surveillance to promptly identify new cases of respiratory viral illness through daily symptom reviews among residents and HCP. Manage exposed or infected individuals with source control, work restrictions for HCP, and Transmission-based Precautions.
- Unit-Specific Quarantine: If transmission is localized to specific units, consider a limited quarantine of those units, restricting group activities or communal dining between affected and unaffected units.
Additional Measures if Initial Interventions Fail:
- Consult Public Health: Seek guidance from the local or state public health department regarding additional interventions.
- Cohort Units: Establish cohort units for residents with confirmed infections to isolate cases.
- Dedicated Staff: Dedicate specific HCP teams to care for residents within cohort units.
- Minimize Staff Movement: Restrict HCP movement between cohort units and unaffected areas of the facility to prevent cross-contamination.
- Limit Communal Activities: Reduce or eliminate group activities and communal dining to minimize potential transmission. Consider limiting access to shared spaces facility-wide.
- Modify Visitation Policies: Re-evaluate and potentially modify indoor visitation policies.
- Visitor Education: Counsel visitors about potential respiratory infection exposure within the facility.
- Room-Based Visits: If indoor visitation proceeds, encourage visits to occur in the resident’s room, discouraging visitors from moving through common areas or interacting with other residents.
- Admission and Transfer Restrictions: Avoid new admissions or transfers into or out of affected units or facility-wide if the outbreak is widespread, to contain the virus within the affected areas.
Resources: Expanding Your Long Term Care Tool Kit Example
This long term care tool kit example is further enhanced by the following 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.
A Outbreak is generally defined as two or more laboratory-confirmed cases of respiratory illness among residents and/or HCP with onset within 72 hours of each other. For SARS-CoV-2, a single new laboratory-confirmed case of SARS-CoV-2 infection in a resident or HCP may also be considered an outbreak in certain situations, particularly in the context of high community transmission or when variants of concern are circulating. Refer to your local and state health department guidance for specific outbreak definitions.
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