For long-term care facilities
The Springfield-Greene County Health Department has worked closely alongside the Missouri Department of Health and Senior Services (DHSS) and with local long-term care facilities to assist with testing, secure Personal Protective Equipment (PPE) and to provide guidance on best practices for disease prevention and containment in an institutional setting.
While it is ultimately DHSS that has the regulatory authority, responsibility and oversight of communicable disease containment in long-term care setting, local public health departments are a partner in serving as a liaison to support the state’s disease prevention strategy. This strategy includes facility-wide testing of staff and residents after a positive test of either a resident or staff, and repeated testing until there are no additional cases.
Long-term care facilities are required to report a positive case among staff or residents to DHSS within 24 hours so guidance can be provided on comprehensive testing, isolation and quarantine instructions, personal protective equipment and staffing. State guidance for long-term care facilities can be found here.
- Get vaccinated.
- Wash hands often with soap and water for at least 20 seconds.
- Avoid touching your eyes, nose, or mouth with unwashed hands.
- Avoid close contact with people who are sick.
- Clean and disinfect objects and surfaces.
- Stay away from others when sick.
- Cover mouth and nose with a tissue when coughing or sneezing then throw the tissue in the trash and wash hands.
In long-term care facilities, it is particularly important that we prevent the spread of any viruses within the facility, as well as, coming into the facility from outside family, friends, visitors and vendors. It is important that we take every precaution to protect you. As prevention measures, care facilities are implementing recommendations to limit visitors to facilities. Facilities are also screening visitors to asses current illness. These measures are being put into place to protect you because older adults with underlying medical conditions are especially at risk.
The following guidelines will help limit the spread of COVID-19 infection among residents and staff.
Click here to view the state's guidance considerations for long-term care facility visits.
- Review and update pandemic influenza preparedness plans. Follow outlined plans.
- Daily monitoring of influenza-like-illness (ILI) among residents and staff.
- Ensure sick leave policies allow employees to stay home if they have symptoms of respiratory infection.
- Restrict residents with fever or acute respiratory symptoms to their room. If they must leave the room for medically necessary procedures, have them wear a facemask (if tolerated). In general, for care of residents with undiagnosed respiratory infection use Standard, Contact, and Droplet Precautions with eye protection.
- Social distancing
- Limit face-to-face contact when possible. Keep people at least 6 feet apart.
- Provide web- and mobile-based communications and services if possible.
- Alter schedules to reduce mixing (e.g., stagger meal, activities)
- Staff restrictions
- If staff have fever or other respiratory symptoms, they should be excluded from work.
- Staff need to self-assess and report symptoms before reporting to work.
- Identify staff whom are at higher risk and assign them to unaffected units.
- Log Activity in and out of the rooms:
- Log sheet with contact information of visitors and what room they visited
- Log sheet at each room to log staff in and out of room
- Plan for cohorting residents and staff.
- Staff only work with those that are quarantined or symptomatic
- Confine symptomatic residents and exposed roommates to their rooms
- Place symptomatic residents together in one area of the facility (unit, wing, etc.)
- Cohort staff on either affected or non-affected units to prevent transmission between units and wings
- Log of symptomatic patients
- Plan in place to be able to have timely reporting to the Health Department
- Staff only work with those that are quarantined or symptomatic
- Long-term care facilities concerned that a resident, visitor, or employee may be a COVID- 2019 patient under investigation should contact their local or state health department immediately for consultation and guidance.
- Protocol for testing for COVID-19 within facility:
- Following standard precautions and use of appropriate PPE, obtain nasopharyngealand oropharyngeal samples provided in test kit, and complete accompanying paperwork.
- Deliver samples to lab using facilities’ established courier service, or call Health Department for assistance.
- Immediately contact Health Department when testing is positive.
- Once resident is identified as suspect and/or tested, they must remain in proper isolation and follow the infection prevention and control practices by the CDC. Facilities without an airborne infection isolation room (AIIR) are not required to transfer the patient assuming:
- The patient does not require a higher level of care
- The facility can adhere to the rest of the CDC infection prevention and control practices recommended for caring for a resident with COVID-19
Clinical Management and Treatment
For information regarding infection prevention and control recommendations, please see Interim Infection Prevention and Control Recommendations for Patients with Confirmed Coronavirus Disease 2019 (COVID-19) or Persons Under Investigation for COVID-19 in Healthcare Settings.
- Patients with a mild clinical presentation of COVID-19 may not initially require hospitalization. However, clinical signs and symptoms may worsen with progression to lower respiratory tract disease in the second week of illness; all patients should be monitored closely. Possible risk factors for progressing to severe illness may include, but are not limited to, older age, and underlying chronic medical conditions such as lung disease, cancer, heart failure, cerebrovascular disease, renal disease, liver disease, diabetes, immunocompromising conditions, and pregnancy.
- The decision to monitor a patient in the inpatient or outpatient setting should be made on a case-by-case basis. This decision will depend not only on the clinical presentation, but also on the patient’s ability to engage in monitoring, isolation, and the risk of transmission in the patient’s living environment.
- No specific treatment for COVID-19 is currently available. Clinical management includes prompt implementation of recommended infection prevention and control measures and supportive management of complications, including advanced organ support if indicated.
- Notify facilities prior to transferring a resident with an acute respiratory illness, including suspected or confirmed COVID-19, to a higher level of care.
- Inform EMS that a patient with suspected or confirmed COVID-19 needs to be transferred, and they should be admitted directly to the hospital, instead of going through the emergency room.
Restrictions, isolation and planning for internal patients
- When a patient is confirmed with COVID-19: (2 options)
- Inform discharge planners at partner hospitals that facility is closed to new admissions.
- Close only a defined section/unit and inform discharge planners of unit closures. Inform new residents of COVID-19 in facility in closed unit/section.
- If allowing units to stay open, define protocol for limiting visitor’s movement throughout Facility.
- Identify dedicated personnel to care for COVID-19 patients. Follow CDC guidelines for surveillance and infection control.
- Isolated patient will remain in isolated room until critical care is needed, and transport is arranged to hospital facility, following CDC guidelines for transfer.
- Post signs on the door or wall outside of residents room that clearly identifies required PPE.
- Cohort symptomatic residents.
- Close units where symptomatic and asymptomatic patients are residing and being monitored.
- Close communal dining hall and all group activities, such as internal and external group activities.
- Provide education for all that covers the following:
- Potential harm from respiratory illnesses to residents.
- Provide education to family members and/or care givers of residents as to why restrictions are in place. Also provide how family members and/or care givers can stay in touch with residents. Sample education/notice.
- Prevention methods for respiratory illnesses such as flu and COVID-19
- Hand Hygiene. Increase handwashing signs in facility and require upon entrance.
- Cough etiquette
- Provide education for staff that covers the following:
- Use of PPE when care for patients with COVID-19.
- When PPE supplies are limited: Transition to extended use of eye and face protection.
- Screening criteria. Example screener
- Restriction criteria. Signage should be posted at entrances for restrictions and screening.
- Use of PPE when care for patients with COVID-19.
- Wash hands often with soap and water for at least 20 seconds
- Avoid touching your eyes, nose, or mouth with unwashed hands
- Avoid close contact with people who are sick
- Clean and disinfect objects and surfaces
- Stay home away from others if you are sick.
- Cover mouth and nose with a tissue when coughing or sneezing then throw the tissue in the
In long-term care facilities, it is particularly important that we prevent the spread of any viruses within the facility, as well as, coming into the facility from outside family, friends, visitors and vendors. Due to the resident’s vulnerability, it is important that we take every precaution to protect the residents. As prevention measures, care facilities are implementing recommendations to limit visitors to facilities unless the visit is necessary. Facilities are also screening all visitors to asses current illness or travel. These measures are being put into place to protect your friend or loved one because older adults with underlying medical conditions are especially at risk.
Plan to contact your family member or friends through other means, such as phone or video conferencing tools.
What to do when someone you know in the facility is diagnosed?
The person who tested positive will be isolated so visitors will not be allowed. You should plan to contact this person through another method.
If you have had close contact with the diagnosed person, you should monitor your health for fever, cough and shortness of breath. If not fully vaccinated, you should not go to work or school and should avoid public places for 7-10 days. The length of quarantine is a minimum of 7-10 days, depending on test results. If the individual is tested after day 5 and receives a negative test result, they can be released after 7 days of quarantine. If they are not tested, they must quarantine for 10 days.
If you are a close contact and become sick with a fever, cough or shortness of breath (even if your symptoms are very mild), you should stay at home and away from other people. You should contact your physician’s office and tell them that you were exposed to someone with COVID-19.
If you have not been in close contact with a sick person with COVID-19 or fully vaccinated, you are considered to be at low risk for infection. You can continue to go to work and school but should monitor your health and say away from others if you get sick.
What is close contact?
- Caring for a sick person with COVID-19
- Being within 6 feet of a sick person with COVID-19 for about 10 minutes OR
- Being in direct contract with secretions form a sick person with COVID-19 (e.g., being coughed on, kissing, sharing utensils, etc)