This toolkit is designed to assist nursing homes and other long-term care facilities in creating and implementing a robust long-term care plan, specifically focusing on preparedness and response strategies for respiratory viral infections affecting elderly residents. It serves as a vital resource for infection preventionists, leadership, and healthcare personnel (HCP) dedicated to safeguarding the health of elderly populations in long-term care settings. By proactively preparing for and effectively responding to respiratory viruses such as SARS-CoV-2, influenza, and RSV, facilities can significantly mitigate the impact of outbreaks and ensure the well-being of their vulnerable residents.
ACTION: PREPARE for Respiratory Viruses
Proactive preparation is the cornerstone of an effective long-term care plan for elderly residents, especially when facing the persistent threat of respiratory viruses. This section outlines essential steps to take before an outbreak occurs, ensuring your facility is well-equipped to protect its residents and staff.
Vaccination: A Primary Defense
Vaccination stands as the most crucial step in preventing severe illness from respiratory viruses. A comprehensive long-term care plan must prioritize and facilitate vaccination for both residents and healthcare personnel.
- Ensure Access and Promote Uptake: Provide easy access to recommended vaccines for all residents and HCP. Utilize resources like the adult immunization schedule to stay updated on current recommendations.
- Educate and Encourage: Implement proactive communication strategies to encourage vaccination. Share informative materials such as visual guides and downloadable resources with families and visitors to underscore the importance of vaccination.
- Partner for Success: Collaborate with pharmacies and public health organizations to ensure a seamless vaccine administration process and to address any logistical challenges in accessing vaccines for your long-term care facility.
Resource Allocation: Planning for Potential Surges
Effective long-term care planning involves anticipating resource needs, especially during a respiratory virus outbreak. Adequate supplies are essential to maintain infection prevention and control (IPC) practices and protect both residents and staff.
- Secure Sufficient Supplies: Ensure your facility has ample stock of essential resources, including personal protective equipment (PPE) and alcohol-based hand sanitizer (ABHS). Proactive procurement prevents shortages that could compromise safety.
- Contingency Planning: Develop a plan to address potential resource limitations and surges in demand. Consider scenarios involving multiple symptomatic individuals and ensure protocols are in place to acquire additional supplies if needed.
Monitor and Mask, Educate, Ventilate, Test and Treat:
These actions are also vital components of preparedness, forming a multi-layered defense strategy within your long-term care plan. While the original article lists these as headings, expanding on them is crucial for a comprehensive toolkit:
- Monitor: Implement robust systems for continuous monitoring of residents and staff for any signs or symptoms of respiratory illness. Early detection is key to rapid response.
- Mask: Establish clear protocols for mask use within the facility, especially during periods of increased respiratory virus transmission in the community. Ensure readily available masks for residents, staff, and visitors.
- Educate: Ongoing education for HCP, residents, and families is paramount. Regularly communicate about respiratory virus prevention, symptoms, and facility protocols. Use various methods like trainings, posters, and family meetings.
- Ventilate: Optimize ventilation systems to improve air quality and reduce the risk of airborne transmission. Explore strategies to enhance air circulation and filtration within the facility.
- Test and Treat: Establish clear pathways for rapid testing of symptomatic individuals and ensure timely access to recommended treatments and prophylactic medications as indicated.
ACTION: RESPOND to Suspected Respiratory Viral Infection
Prompt and decisive action is critical when a resident or HCP exhibits signs or symptoms of a respiratory viral infection. This section of the long-term care plan toolkit outlines immediate response strategies to prevent further spread within the facility and ensure appropriate care.
Preventing Spread: Implementing Transmission-Based Precautions
Containing the spread of infection is the immediate priority. A swift implementation of Transmission-Based Precautions is essential to protect other residents and staff.
For Residents:
- Apply Transmission-Based Precautions: Immediately implement appropriate Transmission-Based Precautions for any resident displaying symptoms of a respiratory infection. This typically includes placing the resident in a single-person room.
- Room Confinement and Safe Movement: Residents under Transmission-Based Precautions should primarily remain in their rooms, leaving only for medically necessary purposes. When leaving their room is unavoidable, ensure they practice physical distancing and wear a facemask for source control.
- Timely Removal from Precautions: Establish clear criteria and protocols for removing residents from Transmission-Based Precautions as soon as they are no longer considered infectious, ensuring a balance between infection control and resident well-being.
For Healthcare Personnel:
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Strict PPE Protocols: HCP entering the room of a resident with suspected respiratory viral infection should rigorously adhere to Standard Precautions. For cases consistent with SARS-CoV-2, this mandates the use of a NIOSH-approved® particulate respirator (N95® or higher), gown, gloves, and eye protection (goggles or face shield). PPE protocols can be adjusted once the specific cause of infection is identified, referring to resources like Appendix A of the 2007 Guideline for Isolation Precautions.
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Non-Punitive Sick Leave Policies: Develop and enforce sick leave policies for HCP that are non-punitive and flexible, aligning with public health guidelines. This encourages responsible behavior, ensuring HCP with respiratory infections stay home for the recommended duration of work restriction, preventing presenteeism and further spread.
Rapid Testing and Treatment:
- Immediate Testing: Test anyone exhibiting respiratory illness signs or symptoms without delay. Rapid diagnostic testing is crucial for identifying the pathogen and guiding appropriate treatment and control measures.
- Prompt Treatment and Prophylaxis: Provide recommended treatment and prophylaxis to infected and exposed residents promptly, following established clinical guidelines. For SARS-CoV-2, this includes staying updated on the latest therapeutic options.
Investigation: Identifying Potential Spread
- Active Investigation: Immediately investigate potential respiratory virus spread among residents and HCP. Contact tracing and surveillance are essential to determine the extent of transmission and implement targeted control measures.
ACTION: CONTROL Respiratory Virus Spread During Outbreaks
When respiratory virus transmission is confirmed within the long-term care facility, escalating control measures are necessary. This section of the long-term care plan toolkit addresses outbreak management, focusing on rapid and coordinated actions to contain further spread.
Notification and Consultation:
- Notify Public Health Authorities: Promptly notify the local or state public health department when respiratory viral outbreaks are suspected or confirmed. This includes outbreaks of COVID-19, influenza, and other respiratory viruses. Public health departments offer valuable expertise in IPC and can provide access to additional testing resources.
Initial Control Measures:
- Reinforce Vaccination: Re-emphasize and offer vaccination to all residents and HCP within the facility. Outbreak situations highlight the critical importance of vaccine protection.
- Enhance Ventilation: Implement supplemental ventilation measures to improve air circulation and air cleanliness throughout the facility, especially in affected areas.
- Universal Masking: Implement universal masking for source control on affected units or facility-wide. This includes requiring masks for all HCP within the facility and for residents when they are around others (e.g., outside their rooms).
- Active Surveillance: Intensify active surveillance efforts to identify new cases of respiratory viral illness. Implement daily or every-shift symptom reviews for both residents and HCP. Proactively manage exposed or infected individuals with source control and work restrictions for HCP and Transmission-Based Precautions for residents.
- Limited Quarantine: If transmission is localized to specific units, consider a limited quarantine of those units. This may involve restricting group activities or communal dining between residents from affected and unaffected units.
Escalated Measures if Initial Control Fails:
- Consult Public Health Department: If initial interventions are insufficient, consult with the local or state public health department for guidance on additional control measures.
- Cohort Units: Establish cohort units for residents with confirmed infections. Dedicate specific HCP teams to these units and minimize movement of HCP between cohort units and unaffected areas of the facility.
- Limit Communal Activities: Further limit or suspend group activities and communal dining to reduce opportunities for transmission. Consider restricting the use of shared communal spaces across multiple units or facility-wide.
- Modify Visitation Policies: Re-evaluate and potentially modify indoor visitation policies. Counsel visitors about potential exposure risks. If indoor visits continue, recommend they occur in the resident’s room, with visitors avoiding other areas of the facility and interactions with other residents.
- Restrict Admissions and Transfers: Avoid new admissions or transfers into or out of units or wards with infected residents, or facility-wide if the outbreak is widespread.
Resources
This long-term care plan toolkit directs you to essential resources from the Centers for Disease Control and Prevention (CDC) for further information and guidance on respiratory virus management:
CDC Information on Specific Respiratory Viruses:
CDC Information on Respiratory Virus Infection Prevention and Testing:
CDC Information on Respiratory Pathogen Vaccination:
Additional Information on Respiratory Pathogen Vaccination:
CDC Information on Respiratory Virus Treatment:
Additional Information on Respiratory Virus Vaccination:
CDC Information for Respiratory Virus Data and Reporting:
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.
