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CMS releases additional infection control guidance in light of COVID-19

The Centers for Medicare & Medicaid Services sent out a notice today regarding extra infection control guidance in light of COVID-19. An outbreak of the virus at Life Care in Kirkland, Wash. that resulted in seven deaths with eight sick has prompted SNFs to take notice and CMS to issue new guidance that includes specific focus areas of surveys.

Life Care Center of Kirkland is part of a chain of more than 200 nursing facilities called Life Care Centers of America, which is based in Tennessee. According to a New York Times article published today regarding COVID-19 in nursing homes, the Life Care Center of Kirkland has been cited previously for infection control violations by the State of Washington, and the federal government.

According to the JAMA, older people and those with certain comorbidities are at higher risk of severe symptoms if they contract COVID-19. Fifteen percent of people older than 80 are killed by the virus. That figure is 8% for people over 70 years old.

At a White House briefing yesterday, Vice President Mike Pence, who is leading the effort to contain coronavirus for the country, announced that his task force has authorized the decision to put “all inspection resources, at the state level, focused on infectious disease, looking at nursing homes being a focal point of vulnerability and a vulnerable population.” In the same briefing, CMS Administrator Seema Verma states that CMS is:

issuing a call to action to hospitals, nursing homes, dialysis providers, and all healthcare facilities to review their infection control and emergency preparedness procedures to ensure that they are in compliance with CMS regulatory requirements.

In addition, we are reissuing some guidance around infection control, around transfers between nursing homes and hospitals, encouraging and requiring them to consult with local healthcare officials. And we’re also issuing some guidance around screening visitors and healthcare workers.

Guidance released includes barring visits by people who are sick and have traveled to affected countries, as well as guidance to determine when to transfer COVID-19 residents. The Centers for Disease Control and Prevention also have offered guidance for SNFs that includes prevention of exposing the facility in the first place. It advises that SNFs:

  • Post signs at the entrance instructing visitors not to visit if they have symptoms of respiratory infection.
  • Ensure sick leave policies allow employees to stay home if they have symptoms of respiratory infection.
  • Assess residents symptoms of respiratory infection upon admission to the facility and implement appropriate infection prevention practices for incoming symptomatic residents.

(More guidance can be found on the CDC website.)

CMS guidance states that SNFs should:

  • Monitor the CDC website for information and resources
  • Contact their local health department with questions or a suspected COVID-19 case.
  • Be vigilant to identify potential cases: frequently monitor for potential symptoms of respiratory infection throughout the day
  • Train and prepare staff to improve infection control and prevention practices
  • Maintain a person-centered approach to care, including communicating effectively with residents and their families

SNFs have the right to restrict visitor access under 42 CFR 483.10(f)(4), and F-tag 563 of Appendix PP of the State Operation Manual. 

The guidelines for visitor restrictions can be found in the CMS report, on page 2.

Staff members who have signs and symptoms of respiratory infection should not work. Staff members who are asymptomatic but might have been exposed should follow CDC guidance.

SNFs should contact their local health department with any suspected or confirmed cases. Residents who have suspected or confirmed cases of COVID-19 do not necessarily need to be transferred to a hospital, depending on the severity of symptoms (and level of care need), the infection control practice of the facility. Before any transfer of such residents, the SNF should contact both the emergency medical services and the receiving facility. Such residents may also potentially be discharged home, depending on circumstances.

CMS makes special note that SNFs should admit any individuals they normally would, even if such individuals are from hospitals handling known COVID-19 cases.

According to the report, SNFs are also to:

  • increase alcohol-based hand sanitizer availability, tissues, no-touch receptacles, and face masks at entrances
  • Increase signage for vigilant infection prevention, such as hand hygiene and cough etiquette
  • Properly disinfect medical equipment
  • Disinfect workplace areas
  • Provide additional work supplies to avoid sharing supplies (for example, pens)

The CMS report links to many additional resources.