Coronavirus Updates

Outbreak Plan                                                         

Policy Statement

Outbreaks of Communicable diseases within the facility will be promptly identified and responded appropriately to decrease the risk of transmission to residents and staff which has a potential to pose a significant public health threat and danger of infection to the residents, resident representatives, and staff of the facility.

Policy Interpretation and Implementation

As required by New Jersey Department of Health N.J.S.A.26:2H-12:87, the facility’s outbreak response plan is built to fit to the facility’s needs. It is based upon national standards and developed in consultation with the facility's infection control committee.
The facility's plan includes but shall not be limited to:

1.    A protocol for isolating and cohorting infected and at-risk residents in the event of an outbreak of a contagious disease until the cessation of the outbreak.

2.    Policies for the notification of residents, residents' families, guardians, visitors, and staff in the event of an outbreak of a contagious disease at a facility.

3.    Information on the availability of laboratory testing, protocols for assessing whether facility visitors are ill, protocols to require ill staff to not present at the facility for work duties, and processes for implementing evidence-based outbreak response measures.

4.    Policies to conduct routine monitoring of residents and staff to quickly identify signs of a communicable disease that could develop into an outbreak; and

5.    Policies for reporting outbreaks to public health officials in accordance with applicable laws and regulations.

Outbreak- is defined as any unusual occurrence of disease or any disease above background or endemic levels.

Endemic Level- means the usual level of given disease in a geographic area.

Pandemic - A sudden infectious disease outbreak that becomes very widespread and affects a whole region, a continent, or the world due to a susceptible population. By definition, a true pandemic causes a high degree of mortality.

Emerging Infectious disease -- Infectious diseases whose incidence in humans has increased in the past two decades or threatens to increase in the near future have been defined as "emerging." These diseases, which respect no national boundaries, include:

·      New infections resulting from changes or evolution of existing organisms

·      Known infections spreading to new geographic areas or populations

·      Previously unrecognized infections appearing in areas undergoing ecologic transformation

·      Old infections reemerging as a result of antimicrobial resistance in known agents or breakdowns in public health measures

Isolation – Separation of an individual or group who is reasonably suspected to be infected with a communicable disease from those who are not infected to prevent the spread of the disease.

Cohorting- means the practice of grouping patients who are or are not colonized or infected with the same organism to confine their care to one area and prevent contact with other patients.

Quarantine – Separation of an individual or group reasonably suspected to have been exposed to a communicable disease but who is not yet ill (displaying signs and symptoms) from those who have not been exposed to prevent the spread of the disease.

Outbreak Phases:

A.    Pre-outbreak phase:

The facility’s Infection Control Preventionist (ICP) will be vigilant and stay informed about infectious diseases around the world and will update the Outbreak Plan as needed as new communicable diseases develop.

·      The Outbreak Plan will be maintained in the Emergency Disaster Plan and Infection Prevention and Control Manual.

·      The facility’s Infection Control Committee (ICC) will serve as the authority for outbreak preparedness and response. The ICC comprises of the Medical Director, Infection Control Preventionist, Administrator, Director of Nursing, Director of Environmental Services, and Human Resources

·      The facility will maintain adequate emergency stockpile of personal protective equipment (PPE) including moisture-barrier gowns, face shields, surgical masks, assorted sizes of disposable N95 respirators, and gloves; essential cleaning and disinfection supplies so that staff, residents and visitors can adhere to recommended infection prevention and control practices.

·      Addressing Engineering controls in coordination with the facility administrator for any appropriate physical plant alterations such as use of private rooms for high-risk residents, plastic barriers, sanitation stations, and special areas for contaminated wastes as recommended by local, state, and federal public health authorities.

B.    Outbreak Heightened Alert Phase:

·      This phase begins when a confirmed case of communicable disease is detected in the community.

·      The Infection Control Preventionist will keep administrative leadership briefed as needed on potential risks of new infections in their geographic location through the changes to existing organisms and/or immigration, tourism, or other circumstances.

·      Assess the facility stock pile of PPE, necessary supplies and equipment and review staffing contingency plans.

·      Assess the availability of vaccines, antiviral medications, and other essential medications from the pharmacy, DHS, as well as state stockpile.

·      Identify crucial gaps in infrastructure, resources and policies that may interfere with an effective response. Action will be taken to resolve.

·      Staff will be educated on the exposure risks, symptoms, and prevention of the infectious disease, with special emphasis on reviewing the basic infection prevention and control, use of PPE, isolation, and other infection prevention such as hand washing.

·      If infectious disease is spreading through an airborne route, then the facility will activate its respiratory protection plan to ensure that employees who may be required to care for a resident with suspected or known case are not put at undue risk of exposure.

·      Provide residents and families with education about the disease and the facility’s response strategy at a level appropriate to their interests and need for information.

·      Brief vendors/contractors on the facility’s policies and procedures related to minimizing exposure risks to residents

·      Establish a command center using the Infection Control Preventionist as coordinator. The Infection Control Preventionist will maintain frequent contact with the Administrator, the Medical Director and Director of Nursing.

·      The administrator and or the Director of Nursing will hold a Staff Meeting to alleviate fear and answer staff concerns.

·      Post signs regarding hand sanitation and respiratory etiquette and/or other prevention strategies relevant to the route of infection at the entry of the facility along with the instruction that anyone who is sick must not enter the building.

·      The Infection Control preventionist will meet with the Clinical team and other essential personnel to keep them informed and prepare them for any changes in their daily activities that may be anticipated. Re-education such as hand washing, donning and doffing of PPE, respiratory protection plan and etc., will be conducted.

·      Alert the Food Service Department to assess the need to stockpile food and water.

·      Review environmental cleaning procedures and frequency such as terminal disinfection, high touch areas, equipment, common areas and other.

·      Staff that are exhibiting signs and symptoms of communicable disease, will be tested, and sent home. They will follow self-isolation and return to work protocol.

·      Inform each department to review staffing contingency plans for any anticipated absenteeism and illness.

·      The Infection Control Preventionist will initiate/maintain Line Listing as a mechanism to track specific infectious disease and symptoms in residents and employee illness related absenteeism increases that might indicate early cases of outbreak

·      Identify and Screen residents, staffs and visitors, based on the outbreak identified.

·      Isolate and or cohort residents with signs and symptoms of infectious disease following the facility’s isolation/cohort plans and in accordance to NJDOH and CDC guidance.

·      Screening and or Diagnostic Testing will be done as warranted to identify specific infectious disease.

·      The Social Service Department will reach out to local Funeral establishments to establish contact and procedures in coordination with the Infection Control Preventionist.

Screening Protocol:

A.    Staff Self Screening -Staff will be educated on the facility’s plan to control exposure to the residents. This plan will be developed with the guidance of public health authorities and may include:

·      Reporting any suspected exposure to the Infectious Disease while off duty to their supervisor and Infection Control Preventionist.

·       Precautionary removal of employees who report an actual or suspected exposure to the infectious disease.

·       Self-screening for symptoms prior to reporting to work.

·      Prohibiting staff from reporting to work if they are sick until cleared to do so by appropriate medical authorities and in compliance with appropriate labor laws.

·      Will communicate with the Infection Preventionist nurse and or the Director of Nursing for clearance to return to work.

·      Facility shall screen and log HCP and everyone entering the facility for symptoms of the infectious disease.

Screening will include:

·      Temperature checks including subjective and/or objective fever equal to or greater than 100.4 degrees Fahrenheit or as further restricted by the facility.

·      Completion of questionnaire  thru advance entry screening process;

·      Facility will screen all HCP at the beginning of their shift.

B.    Residents and Visitors – Identify and Screen residents, staff and visitors, based on the outbreak identified.

Residents:

·      Facility will conduct active screening of all residents:

•     Nursing Staff will monitor residents minimum of daily for symptoms of infectious disease including monitoring of vital signs.

·      Specific symptoms of infectious diseases will be identified and all residents will be monitored for these symptoms, as well as history of travel in affected geographic areas listed by the State DOH of the date of the visit within 14 days of onset, (or if otherwise specified by CDC).

·      Resident will be monitored for signs and symptoms related to the infectious disease for those having confirmed close contact with someone that was infected.

Visitors:

·      Facility will conduct active screening of all visitors including vendors, nonessential healthcare personnel/contractors prior to visitation or entering the facility.

o  These services can continue with a policy for services to be rendered in a safe manner to include but not limited to infection control and precautions, physical distancing, hand hygiene, cleaning between clients for the barber/hair stylist and the use of well fitting source control. 

·      Screening will include:

a.    Temperature checks including subjective and/or objective fever equal to or greater than 100.4 degrees Fahrenheit or as further restricted by the facility.

b.    Completion of questionnaire thru advance entry screening process;

c.    Visitor and or vendors will not be permitted to enter facility or visitation will be restricted for a positive screen.

d.    Employee testing based on the Community Transmission Scores and the outbreak status of the building. Change effective with the Executive Order-21-011

C.    Source Control:

·      Universal Masking for all staffs, and visitors will be required when entering the facility as directed by the ICP.

·      All staffs and visitors will maintain social distancing, six feet apart while at the facility unless the resident is fully vaccinated and choses close contact with mask wearing

·      Visitors are encouraged to perform hand hygiene prior to visiting and will observe respiratory etiquette protocols.

D.   Outbreak Phase:

This phase begins when there is a confirmed case of communicable disease in the facility following the outbreak definition in accordance to NJDOH guidance.

·      The Infection Control Preventionist (ICP) will direct the facility’s planning and response efforts and is responsible for surveillance and is constant contact with the local and State Department of Health and notification of cases in accordance to mandated NJDOH, CDC reporting for communicable diseases.

a.     During the infectious disease outbreak, mechanisms for monitoring employee absenteeism for increases that might indicate early cases of outbreak will be utilized.

b.    Line listings will be utilized/maintained as mechanisms for tracking facility admissions and discharges of suspected or laboratory-confirmed cases of the specific infectious disease outbreak in residents to support local public health personnel in monitoring the progress and impact of the outbreak

c.    Assess bed capacity and staffing needs, and detect a resurgence in cases that might follow the first wave of cases

d.    Update information on the types of data that should be reported to the state agency and/or local health departments (e.g., admission; discharges/deaths; resident characteristics such as age, underlying disease, and secondary complications;

e.    Monitor illnesses in healthcare personnel and plans for how this data will be collected during an outbreak

f.     Establishes criteria for distinguishing the type of outbreak from other respiratory diseases.

·      The Infection Control Committee (ICC) will work with the ICP and assist with decision-making during an outbreak.

·      Adhere to Standard and Transmission-based Precautions including use of a facemask, gown, gloves, and eye protection for confirmed and suspected case(s).

·      Facilities located in areas with moderate to substantial community transmission are more likely to encounter asymptomatic or pre-symptomatic individuals with COVID-19 incubation or infection. Community transmission levels can be assessed by referring to the NJDOH COVID-19 Activity Level Index at https://www.nj.gov/health/cd/statistics/covid/index.shtml. Universal eye protection in addition to source control and other infection prevention and control measures, should be instituted to ensure the eyes, nose, and mouth are all protected from exposure to respiratory secretions, for all HCP and for all individuals who are unable to maintain social distancing.

·      Provide all assigned staff additional training and supervision in the mode of transmission of this ID, and the use of the appropriate PPE.

·      Assign dedicated staff to enter the room of the isolated person as feasible. Ideally, only specially trained staff and prepared (i.e. vaccinated, medically cleared and fit tested for respiratory protection) will enter the isolation room.

·      Implement the isolation protocol in the facility (isolation rooms, cohorting) as described in the facility’s infection prevention and control plan and/or recommended by local, state, or federal public health authorities.

·      Activate quarantine interventions for residents and staff with suspected exposure as directed by local and state public health authorities, and in keeping with guidance from the CDC.

·      Suspend or limit visits on the affected unit/area.

·      Administer available vaccines and antivirals according to priority group

·      If mortality becomes an issue, facility will contact family pre-arranged Funeral homes or New Jersey state Temporary Morgues designated catchment area.

COHORTING: The facility will cohort residents as follows and as directed by NJDOH and CDC:

·      Cohort 1 –Positive for Infectious disease outbreak. (COVID 19)

·      This cohort consists of both symptomatic and asymptomatic patients/residents who test positive for COVID-19, regardless of vaccination status, including any new or re-admitted patients/residents known to be positive who have not met the criteria for discontinuation of Transmission-Based Precautions. If feasible, care for COVID-19 positive patients/residents on a separate closed unit. Patients/residents who test positive for COVID-19 are known to shed virus, regardless of symptoms; therefore, all positive patients/residents would be placed in this positive cohort.

·      Cohort 2 – Negative, Exposed:

·      This cohort consists of symptomatic and asymptomatic patients/residents who test negative for COVID-19 with an identified exposure (i.e., close contact) to someone who was positive, regardless of vaccination status. This includes new or re-admitted patients/residents who have tested negative and have been identified as a close contact in the past 14 days. Exposed individuals should be quarantined for 14 days from last exposure, regardless of negative test results or vaccination status. All symptomatic patients/residents in this cohort should be evaluated for causes of their symptoms. Patients/residents who test negative for COVID-19 could be incubating and later test positive. To the best of their ability, facilities should separate symptomatic and asymptomatic patients/residents, ideally having symptomatic housed in private rooms. Even though symptomatic COVID-19 negative patients/residents might not be a threat to transmit COVID-19, they still may have another illness, such as influenza. Asymptomatic patients/residents should be closely monitored for symptom development. Patients/residents who are identified as close contacts should be quarantined for 14 days and initially tested. If testing is negative, the patient/resident should be tested again 5-7 days after exposure. If testing remains negative, patients/residents should complete the remainder of their 14-day quarantine period. Testing at the end of this period could be considered to increase certainty that the person is not infected.

·      Cohort 3 – Negative, Not Exposed:

·      This cohort consists of patients/residents who test negative for COVID-19 with no COVID-19 like symptoms and are thought to have no known exposures. This cohort includes all individuals who have clinically recovered from SARS-CoV-2 within 90 days of symptom onset or positive test, and all fully vaccinated individuals who have not been in close contact with a suspected or known COVID-19 case. The index of suspicion for an exposure should be low, as COVID-19 has been seen to rapidly spread throughout the postacute care setting. In situations of widespread COVID-19 transmission in a facility, all negative persons in a facility would be considered exposed. Cohort 3 should only be created when the facility is relatively certain that patients/residents have been properly isolated from all COVID-19 positive and incubating patients/residents and HCP. Given facility-wide transmission levels, Cohort 3 may or may not be applicable.

·      Cohort 4 – New or Re-admissions observation:

·       Unvaccinated, new or readmission observation: These individuals consist of all unvaccinated new patients/residents from the community or other healthcare facilities and unvaccinated re-admitted patients/residents who left the facility for ≥24 hours. This cohort serves as an observation area where persons remain for 14 days to monitor for symptoms that may be clinically compatible with COVID-19. Testing at the end of this period could be considered to increase the certainty that the person is not infected. In most circumstances, quarantine is not recommended for unvaccinated patients/residents who leave the facility for <24 hours and do not have close contact with a suspected or known COVID-19 positive person.

·      EXCEPTIONS TO CONSIDER: COVID-19 positive persons who have not met the criteria for discontinuation of Transmission-Based Precautions should be placed in Cohort 1. Individuals who have met the criteria for discontinuation of Transmission-Based Precautions and it has been < 3 months after the date of symptom onset or positive viral test (for asymptomatic) of prior infection generally* require no further restrictions based on their history of COVID-19 and may go to Cohort 3. New or re-admitted patients/residents who are fully vaccinated and have not been in close contact with a suspected or known COVID-19 case can go to Cohort 3.

·      *Consideration needs to be given to determine whether there is concern that there may have been a false positive viral test, whether the patient/resident is immunocompromised, and whether there is evidence of exposure to a novel SARS-CoV-2 variant. If a patient/resident experiences new symptoms consistent with COVID-19 and an evaluation fails to identify a diagnosis other than SARS-CoV-2 infection (e.g., influenza), then repeat viral diagnostic testing and isolation may be warranted even if they have clinically recovered within 3 months.

Outbreak recommendations

In the event of widespread identified cases, focus should be placed on Cohorts 1 and 2. New admissions should stop until control measures are effectively instituted. Depending on a variety of factors (e.g., facility layout, private room availability, testing results) facilities may not be able to effectively cohort, as described above.

In situations where COVID-19 positive persons are located on multiple units/wings, the facility should follow the below recommendations:

Implement universal Transmission-Based Precautions using COVID-19 recommended PPE (i.e., NIOSH approved N95 or higher level respirator [or well-fitting face mask if unavailable], eye protection, gloves, and isolation gown) for the care of all patients/residents, regardless of presence of symptoms or COVID-19 status.

 • Refer to CDC Optimizing PPE Supplies at https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe/strategy/index.html

 o These strategies offer a continuum of options for use when PPE supplies are stressed, running low, or exhausted.

 o Optimization strategies are meant to be considered and implemented sequentially (i.e., conventional > contingency > crisis). o Healthcare facilities should promptly resume conventional or standard practice as PPE availability returns to normal.

 • Consider repurposing unused space such as therapy gyms, activity and dining rooms during this time to cohort patients/residents. Refer to the NJDOH COVID-19 Temporary Operational Waivers and Guidelines at https://www.nj.gov/health/legal/covid19/.

  • If there are multiple cases on the wing/unit and when movement would otherwise introduce COVID19 to another occupied wing/unit, do not relocate them. Ensure appropriate use of engineering controls such as curtains to reduce or eliminate exposures from infected individuals. Rapid isolation is key. Once there are multiple cases or exposures on a wing/unit, transition the wing/unit to the appropriate cohort and focus efforts on rapid implementation of control measures for unaffected wings/units (i.e., containment efforts).

 • When spacing permits, COVID-19 positive individuals should be relocated to the dedicated COVID-19 positive area (Cohort 1). Otherwise, limit the movement of all patients/residents and HCP in general.

 • Ensure appropriate use of engineering controls, such as curtains between patients/residents, to reduce or eliminate exposures from infected individuals. This is especially important when semi-private rooms must be used. Allocate private rooms to maintain separation between patients/residents based on test results and clinical presentation. For example: o COVID-19 positive persons may share a semi-private room to keep them grouped together.

 § Patients/residents who are colonized with or infected with multidrug-resistant organisms (MDROs), including Clostridium difficile, should not be placed in a semiprivate room or group area when possible, unless their potential roommate(s) is/are colonized or infected with the same organism(s). o Private rooms may be allocated to isolate COVID-19 positive persons or quarantine close contacts, based on availability.

 • Prioritize maintaining dedicated HCP to a wing/unit with a heightened focus on infection prevention and control audits (e.g., hand hygiene and PPE use) and providing feedback to HCP on performance

Documentation of outbreak-

a.    Date and time of the first sign or symptom, when testing was conducted, when results were obtained, and the actions taken based on the results

b.    Document the time and date of a new COVID 19 case in the facility, document the date the case was identified, the date that other residents and staff are tested, the dates that staff and residents who tested negative are retested, and the results of all tests.

 Laboratory Testing:

·      Facility has a contract agreement in-place with licensed laboratory company to perform laboratory testing.

·      If a 48 hour turn around time cannot be met for results, the facility will document all efforts to obtain the quicker turn around results with the identified laboratory and contact the localand state department of health

·      The facility has access to BinaxNow rapid tests as well.

·      Diagnostic testing to identify specific infectious disease and Testing for infectious diseases such as COVID-19 for residents will be conducted in consultation with the local and state departments, the resident primary physician/ Medical Director and in accordance with NJDOH, CDC and other applicable regulatory testing requirements.

·      The resident, resident representatives, and the physician will be informed when performing a diagnostic or surveillance testing. 

·      Routine testing and other appropriate diagnostic and surveillance testing for all staff including vendors will be conducted in accordance with NJDOH, CDC and other applicable regulatory testing requirements.

·      Documentation of testing-

o  Staff

§ Name

§ Date of testing

§ Result of each test

o  Resident

§ Order to do the testing

§ Documentation in the EHR

·      Testing was offered

·      Completed

·      Results of the testing

·      Staff or residents that have tested positive will not require further testing for 90 days from the date of their positive test

·      Staff who test positive will RTW as per the CDC guidelines and when appropriate to their previous position

·      Staff who are fully vaccinated do not require testing unless they are symptomatic and/or the building is in outbreak testing.

·      Refusal of Testing-

o  Resident Refusal

§ Shall treat the individual as a PUI

§ Make a notation in the resident’s chart

§ Notify any authorized family members or legal representatives of this decision.

§ Continue to check temperature on the resident at least twice per

§ Onset of temperature or other symptoms consistent with COVID-19 require immediate cohorting in accordance with the Plan.

§ At any time, the resident may rescind their decision not to be tested.

o  Employee Refusal

§ Employee will be removed from the schedule as this is a requirement of employment.

When prioritizing individuals to be tested, prioritizing individuals with signs and symptoms of COVID-19 first, then perform testing triggered by an outbreak investigation (as specified below).

 
Testing Trigger

• Staff
• Residents
• Symptomatic individual identified
• Staff, vaccinated and unvaccinated, with signs or symptoms must be tested.

Residents, vaccinated and unvaccinated, with signs or symptoms must be tested.

Newly identified COVID-19 positive staff or resident in a facility that can identify close contacts

Test all staff, vaccinated and unvaccinated, that had a higher-risk exposure with a COVID-19 positive individual.

Or test all staff

Test all residents, vaccinated and unvaccinated, that had close contact with a COVID-19 positive individual or test all residents

Newly identified COVID-19 positive staff or resident in a facility that is unable to identify close contacts

Test all staff, vaccinated and unvaccinated, facility-wide or at a group level if staff are assigned to a specific location where the new case occurred (e.g., unit, floor, or other specific area(s) of the facility).

Test all residents, vaccinated and unvaccinated, facility-wide or at a group level (e.g., unit, floor, or other specific area(s) of the facility).

Routine Testing                       Based on Regional Positivity         Test all Unvaccinated staff as per the                                                             Score                                      below grid and/or two times per week

       TESTING PROCEDURES AND FREQUENCY

·      Facilities may use any viral testing (e.g. PCR or antigen) and collection method (e.g. swab or saliva) approved by the United States Food and Drug Administration (FDA)

·      During moderate and high community transmission scores, facility may request but not require, visitors to be tested on their own prior to coming to the facility (e.g. within 2-3 days) with proof of negative results and date of test: the visitor can provide proof of a negative FDA approved or authorized point-of-care test collected and performed in the past 24 hours or PCR test collected and resulted no more than 3 days prior to the visit

·      Facilities that have POC testing available are encouraged to use it as part of their visitor screening process, in particular during high/very high Community Transmission scores in the region. Visitors who test positive are not permitted to enter the building

·      Routine testing should be based on the extent of the virus in the community, therefore facilities should use the regional positivity rate report in the COVID-19 Activity Level Index (CALI) weekly Report: https://www.nj.gov/health/cd/statistics/covid/

·      Use the prior week to determine testing frequency

·      Regional CALI Level/ Regional % Positivity rate in past week Minimum Testing

o  Cali scores                   Community transmission    Testing

o  Low                             <3%                                     Once a week

o  Medium                     <3-10%                                    Once a week

o  High/Very High          >10%                                       Twice a week

·      Further retesting will be completed in accordance with CDC guidance, as amended and supplemented. The facility will consider establishing a routine interval of retesting.

·      Staff that are fully vaccinated do not need to be tested unless symptomatic and/or the building is in outbreak testing of all staff

Communication Methods:

Facility will prominently display facility’s website and or social media platforms to include communication to resident representatives and the public; and provide a phone number or method of communications for urgent calls or complaints.

·      Facility will create and maintain a text list or email serve list.

·      Facility will provide alternative methods of communication to include phone, video-communication, Facetime and etc., with residents and families and resident representatives. The facility designated person will serve as a “visual coordinator” to arrange, coordinate time schedules with residents and families

·      The facility will provide a cumulative update for residents and resident representatives and families at least once weekly through text messages, letters or email listserv communications during a curtailed visitation period. The updates will include information about any infectious disease outbreaks as required by NJDOH, information on mitigating actions implemented by the facility to prevent or reduce the risk of transmission, to include if facility normal operations will be altered.

·      The administrator and or facility designated staff will update website, to share the status of the facility and information that helps families to know what is happening in the facility’s environment such as food menus, schedule activities and etc.

·      Administrator or facility designated staff will notify each resident and resident representative by 5pm the next calendar day following the occurrence of a single confirmed COVID case or 3 or more residents or staff with new onset respiratory signs and symptoms within 72 hours of each other, and follow state, federal guidelines regarding notification of other infectious diseases.

Outbreak Reporting:

·      In the event of an outbreak, the facility will immediately report/notify and consult with the Local/State Public Health Department for specific directions.

·      The Infection Control Preventionist and or the facility administrator is the designated staff to report to the local and State Department of Health and notification of cases in accordance to NJDOH, CDC in accordance with applicable laws and regulations in reporting for communicable diseases.

·      The administrator and or the Infection Control Preventionist will notify the Medical Director, resident, resident representatives and staff for any occurrence of an outbreak and mitigating actions implemented by the facility through resident in person notification by the Social worker or designee, during resident council meetings, signage, emails, memos, facility website, family/resident representatives weekly calls, and staff in-services, phone calls or staff group text messaging.

·      The facility will report to National Healthcare Safety Network (NHSN) two times per week during an outbreak

o  Counts of residents and facility personnel with-

§ Suspected cases

§ Confirmed cases

o  Counts of facility personnel whose death is

§ Suspected to have been caused by the infectious disease

§ Confirmed by a laboratory test to have been caused by the infectious disease

o  Total number of residents

o  Current resident census

o  Staffing shortages

o  Quantity and number of days the current inventory will last

§ Personal protective equipment

§ Hand hygiene supplies

§ Cleaning supplies

§ Sanitation supplies

o  Any other metrics that the Commissioner deems appropriate

o  Flu season

§ Employees who received the flu vaccine

§ Employees who declined flu vaccine due to medical reasons with an authorized medical exemption

§ Employees who declined the flu vaccine NOT due to medical reasons

·      N.J.S.A. requires each LTC to implement by June 13, 2021 a system within the EHR with the Office of National Coordinator for Health Information Technology in the US Department of Heal and Human Services that

o  Is capable of information sharing

§ Including admission, discharge, and transfer and continuity of care through the clinical data by connecting with New Jersey Health Information Network

o  Completed 5-19-2021

Staffing Strategies:

·      Assign a facility representative for conducting daily assessment of staffing status and needs during a staffing shortage

·      All employees in the facility will be notified of the decision to utilize emergency staffing strategies.

·      Cancel all non-emergency procedures or outpatient consults

·      Review staffing protocols and consistent assignment

·      List essential staff/positions

·      List non-essential staff/positions

·      Assigning non-direct care to support staff and or administrative staff.

·      Utilizing nursing school graduates to assist with patient care.

·      Utilizing nursing students for non-direct care and or

·      Contract with local Staffing Agencies to secure staff

·      Overtime and other incentivized strategies

·      Hire non license support staff to assist nursing for non-direct care. Be aware of state-specific emergency waivers or changes to licensure requirements or renewals for select categories of HCP.

·      Infection Preventionist and Human Resource will continue to follow through with employees who are out sick or furloughed related to COVID-19 screening to return to work if cleared following CDC and DOH guidelines.

·      On call rotation for management staff

·      Cancellation of vacation or day off

·      Recruiting retired health care workers

·      12- hour shifting for Nurses and CNA’s

·      Develop task force teams, Nurses, CNA’s management staff to work during staffing crisis

·      Determine business interruption and virtual work options.

·      Hiring of Medical Technicians (MRT) and Certified Home Health Aides (HHA) to function as a role of CNA’s following NJDOH temporary nurse staffing waiver related to COVID-19 State of Emergency plan.

·      Attempt to address social factors that might prevent HCP from reporting to work such as transportation or housing if HCP live with vulnerable individuals.

Post Outbreak Phase:

·      The Infection Control Preventionist will coordinate with the NJDOH, local and or state the cessation of an outbreak.

·      The Infection Control Committee will convene and assess the response of the outbreak and make adjustments to the plan, as appropriate (with recommendations from NJDOH).

·      The facility will return to Pre- Outbreak phase.