Yesterday, the Centers for Medicare & Medicaid Services (CMS) issued several QSO Memos in conjunction with several updates from its website that coincided with an update provided by Vice President Pence and his Task Force members. CMS issued an initial QSO Memo on February 6, 2020, “Information for Healthcare Facilities Concerning 2019 Novel Coronavirus Illness (2019-nCov)” (Ref: QSO-20-09-ALL) which included information from the CDC that was recommended for review. The new March 4, 2020 QSO Memo, “Guidance for Infection Control and Prevention of Coronavirus Disease 2019 (COVID-19) in nursing homes” includes additional guidance to nursing homes to help them improve their infection control practices and prevent the transmission of COVID-19.
CMS states that providers should:
- Monitor the CDC website for information.
- Increase the availability and accessibility of alcohol-based hand sanitizer, tissues, no-touch trash receptacles and facemasks at facility entrances, waiting rooms and other areas.
- Ensure that alcohol-based hand sanitizer is easily accessible in all resident care areas, including both inside and outside resident rooms.
- Implement the use of increased signage related to Infection Control throughout the facility.
- Ensure that shared resident medical equipment is properly cleaned, disinfected and sharing is limited.
- Increase available work supplies for staff such as pens/paper to reduce sharing needs.
- Disinfect workplace areas, especially shared areas/items such as nurses’ stations and phones.
Resident-Specific Information
The QSO Memo states that residents with COVID-19 infections may vary in severity of symptoms and initially, symptoms may be mild. If the symptoms are mild, so long as the facility can follow CDC-recommended Infection Prevention and Control practices, the resident may not need to be transferred to the hospital. The CDC website for Healthcare Professionals related to COVID-19 can be found here.
- If providers have questions OR suspect one of their residents may have COVID-19, they should contact their local health department.
- Facilities should be vigilant in identifying possible cases of COVID-19 so that they can be promptly triaged and isolated as necessary. This includes “frequent monitoring for potential systems of respiratory infection as needed throughout the day.”
- Providers should ensure they are communicating effectively with residents/representatives and/or their families and ensure that they understand their residents’ individual needs and continue to provide person-centered care.
- For residents who require a hospital transfer: The facility should alert the receiving facility and Emergency Medical Services (EMS) about the patient’s condition. The resident should have a facemask placed on him/her and precautions should be taken.
- Accepting a resident diagnosed with COVID-19 from a hospital: Guidance is provided in the QSO Memo regarding how a nursing home can accept this type of patient who is still under Transmission-based Precautions so long as it can follow CDC guidance for these precautions. Providers can view CDC Interim Guidance for Discontinuing Transmission-Based Precautions or In-Home Isolation for Persons with Laboratory-confirmed COVID-19 for more information here.
Staff-Related Information
CMS recommends that staff are screened using the following criteria:
- International travel within the last 14 days to restricted countries.
- Signs/symptoms of a respiratory infection (cough/fever/sore throat, etc.). Healthcare staff who have signs and symptoms of respiratory infection should not report to work.
- Contact with an individual who has or is under investigation for COVID-19.
If any staff members develop signs/symptoms of a respiratory infection while at work, that individual should take the following steps:
- Immediately discontinue working
- Put on a facemask
- Self-isolate at home
- Inform the facility’s Infection Preventionist
- Provide information regarding any individuals, equipment and locations that the staff member came into contact with
- Contact the local health department and follow its recommendations for next steps
Visitor-Related Information
- Facilities should screen visitors with criteria provided above for staff (included in the QSO Memo) and restrict their entry if they meet that criteria. Per F563, facilities can restrict/limit visitation rights for reasonable clinical or safety reasons, including for preventing community-associated infections or transmission of a communicable disease to the residents. Residents’ risk factors for infection and current health state should be considered when visitor restrictions are being made.
View the entire CMS QSO Memo, “Guidance for Infection Control and Prevention of Coronavirus Disease 2019 (COVID-10) in nursing homes” (QSO-20-14-NH). This memo includes links to many helpful resources. Our team at CMSCG has also been putting together a list of relevant COVID-19 resources that can be located here and will be updated as we get more information. Nursing home providers can also view information regarding CMS QSO Memo “Suspension of Survey Activities” issued on March 4, 2020 by checking out this CMSCG Blog link.
Should you require consultative assistance from our Clinical Consulting team, you can email us at info@cmscg.net or call 631.692.4422 to discuss how we can work together to ensure your organization’s Infection Prevention and Control practices are sound.