Coronavirus / COVID-19 Preparedness and Response Plan

Updated 08/11/2020

Table of Contents

Introduction…………………………………………………………………………………………………………………… 3

Students……………………………………………………………………………………………………………………….. 7

Screening of students and staff………………………………………………………………………………….. 10

COVID-19 Screening………………………………………………………………………………………………….. 18

Snack area…………………………………………………………………………………………………………………. 19

Classroom………………………………………………………………………………………………………………….. 23

Environmental Cleaning and Disinfection…………………………………………………………………… 25

Personal Protective Equipment………………………………………………………………………………….. 26

Fit Testing of N95 Respirators……………………………………………………………………………………. 30

PPE Shortages / Optimizing Supply…………………………………………………………………………… 35

If a student Has Symptoms………………………………………………………………………………………… 40

Confirmed COVID-19 – ……………………………………………………………………………………………… 42

Clearing Students with COVID-19 from Transmission-Based Precautions…………………. 45

Online work………………………………………………………………………………………………………………… 47

Confirmed COVID-19 – Staff………………………………………………………………………………………. 49

Staff Returning to Work Criteria………………………………………………………………………………….. 52

Staff Exposure to COVID-19………………………………………………………………………………………. 54

COVID-19 Testing………………………………………………………………………………………………………. 57

Nasal Swab (Anterior Nares) Specimen Collection…………………………………………………….. 61

Staffing Backup Plan………………………………………………………………………………………………….. 62

Shelter in Place………………………………………………………………………………………………………….. 63

Memory Care……………………………………………………………………………………………………………… 65

Training Webinar Videos……………………………………………………………………………………………. 68

Additional Resources………………………………………………………………………………………………….. 69

Introduction

The information contained herein is adapted from the Centers for Disease Control and Prevention and the World Health Organization. The Coronavirus situation is frequently changing. Follow any guidance or instructions from health care providers; local or state health departments; state regulatory agencies; and your organization’s policies and procedures.

Coronavirus disease 2019 (COVID-19) is a respiratory illness that can spread from person to person. The virus that causes COVID-19 is a novel coronavirus that was first identified during an investigation into an outbreak in Wuhan, China. COVID-19 is a disease caused by a new coronavirus, which has not been previously identified in humans. Coronaviruses are a large family of viruses found in both animals and humans.

Symptoms of COVID-19

For confirmed coronavirus disease 2019 (COVID-19) cases, reported illnesses have ranged from mild symptoms to severe illness and death. Symptoms may appear 2-14 days after exposure to the virus. Students with these symptoms or combinations of symptoms may have COVID-19:

• Fever or chills
• Cough
• Shortness of breath or difficulty breathing
• Fatigue
• Muscle or body aches
• Headache
• New loss of taste or smell
• Sore throat
• Congestion or runny nose
• Nausea or vomiting
• Diarrhea

Transmission

There is still more to be learned, but according to the CDC, the virus is thought to spread mainly from person-to-person.

• Between students who are in close contact with one another (within about 6 feet)
• Via respiratory droplets produced when an infected person coughs or
• These droplets can land in the mouths or noses of students who are nearby or possibly be inhaled into the

It may be possible that a person can get COVID-19 by touching a surface or object that has the virus on it and then touching their own mouth, nose, or possibly their eyes, but this is not thought to be the main way the virus spreads.

Prevent Introduction of the Virus

Our senior living communities serve a population that is generally more vulnerable to infection and serious related symptoms. We encourage everyone to remain calm but take the time to prepare your classroom now. Our first goal is to prevent introduction of the virus to our communities. The CDC and local health departments have recommendations we are following regarding:

1. Respiratory etiquette
2. Hand hygiene
3. Limiting visitors
4. Screening staff and visitors
5. Manage start dates / returning students
6. Restricting activities and dining services
7. Environmental cleaning
8. Use of personal protective equipment

Be Prepared

Take these steps to prepare your classroom.

1. Monitor your state and local health departments for additional information and recommendations.

2. Prepare your employees – We want our staff to be informed and prepared. Your review should include:
   • Infection control policies including hand hygiene, cough etiquette
   • Personal protective equipment
   • Staying home when sick
   • Focus on facts from verified resources, such as the CDC and the WHO

3. Gather supplies – You will want to have supplies on hand in the event your classroom is directly impacted by the outbreak, including:
   • Personal protective equipment (gloves, masks, gowns, eye protection)
   • Hand hygiene supplies
   • Disinfecting supplies (bleach, )
   • Apartment meal delivery supplies (Styrofoam, paper, plastic, cups, utensils)

4. Review infection control protocols, with a focus on hand hygiene, droplet/respiratory precautions, and personal protective

5. Develop a communication plan – Give clear and direct communication to your staff, students, and families. Be prepared to communicate with the media should you be approached. Focus on letting everyone know you are following CDC and health department

Encourage Good Respiratory Etiquette

All persons in the classroom, including staff, students and visitors are to be reminded and instructed to practice good respiratory etiquette.

1. Cover your mouth and nose with a flexed elbow or tissue when coughing and sneezing. Throw away the used tissue immediately and wash your hands with soap and water or use an alcohol-based hand

2. Maintain social distance – If possible, keep a distance of 6 feet between yourself and someone who is coughing, sneezing or has a

3. Avoid touching your eyes, nose and mouth – Hands touch many surfaces which can be contaminated with the virus. If you touch your eyes, nose or mouth with your unclean hands, you can transfer the virus from the surface to

Hand Hygiene

All persons in the classroom, including staff, students and visitors are to be reminded and instructed to practice good hand hygiene.

1. This can be done with an alcohol-based hand sanitizer with at least 60% alcohol or by washing hands with soap and water for at least 20

2. Especially after going to the bathroom; before eating; before and after all students care; and after blowing your nose, coughing, or

3. Always wash hands with soap and water if hands are visibly

Visitors

1. Follow your state and local health department guidelines regarding

2. All persons entering the classroom must be screened for signs and symptoms or possible exposure to COVID-19. Use the visitor screening

3. Essential Visits Only: If your classroom is prohibiting visitors, follow these guidelines:

1. Restrict visitation of all visitors and non-essential

1. Necessary medical personnel will be allowed in the classroom (home health, hospice, )

1. Families should be allowed to visit for certain compassionate care situations, such as an end-of-life

• In some states/counties more advanced restrictions on visitors may be required, such as travel based

1. If someone is making an essential visit, they should:

1. Wear a mask while in the classroom, and use all other PPE as needed in accordance with CDC

1. Limit their visit to the students’s apartment

• Not have contact with other

1. Limit contact with staff members.

1. They should not spend time in common areas and always practice social

1. Limit the number of visitors to avoid overcrowding the

1. End of life / Compassionate Care Visits

1. Visits are allowed for end of life situations. This visit must occur following the essential visitor practices (screening, masks, ).

1. Whether a students on hospice is at the stage to require an end of life visit should not be decided by classroom staff. Ultimately the decision as to whether a students is at this point should be made by either the hospice agency and/or the students’s physician. If they indicate that a students is at that point, the classroom should work with the family/responsible party to develop a visitation plan/schedule that is appropriate for the

4. Non-Essential Visits Allowed: If your state/county is allowing visitors, follow these guidelines:

1. Only allow non-essential visits if all of the following conditions are met:

1. It is allowed by your state/county.

1. There have been no cases of COVID-19 in your classroom in the past 14 days.

• Your classroom has adequate supplies of PPE and cleaning supplies.

1. Your classroom has adequate access to COVID-19

1. Limit visits to outdoor spaces unless weather or other factors make this unsafe.

1. Visits must be scheduled in

1. Limit the number of students in the classroom at one time to a manageable number.

1. Visitors must wear a facemask at all times while in the

19. Visitors must be screened for signs and symptoms or possible exposure to COVID-19. Use the visitor screening

1. Visits should occur in an area where visits can be managed/monitored, preferably

1. Limited visitors must follow social distancing guidelines. This includes staying at least 6 feet away from the students they are

1. Clean and disinfect visitation areas between

1. Visitors may not participate in small group dining or

5. Use technology to help family members communicate with students. This can include telephone, video conferences, or mobile devices (e.g., Facetime).

6. Post appropriate signage informing students of your visitation policy and reminding them not to visit if they have symptoms of respiratory

7. Ensure hand sanitizer is readily available at

8. Deliveries from pharmacy and suppliers should be occur in one gathering place that limits the delivery person from having access to the

9. Talk to home health, hospice, and other outside agencies to ensure your infection control efforts are being

10. Marketing tours should be discontinued or severely limited in accordance with company policies. Utilize alternative methods to provide marketing or sales information (e.g., video conferencing).

Screening of Students, Staff, and Visitors

1. All persons entering the classroom should be screened for signs and symptoms or possible exposure to COVID-19. A recommended screening form is provided on the following

2. Existing students should be monitored/screened for signs and symptoms at least once per day, including taking

3. Screening should include taking the temperature of each person as they arrive at the

1. Temperatures should be taken using a reliable touch less thermometer. If one is not available and an ear or other thermometer must be used, use an appropriate probe cover and disinfect according to manufacturer instructions. Avoid using an oral

1. Supportive staff (e.g., concierge or receptionist) should be trained in the proper technique for taking a temperature, the use of the specific device, and infection control

4. All visitors should be screened each day they are in the

5. Screening of staff should be at the start of every

1. Implement sick leave policies that are non-punitive, flexible, and consistent with public health policies that allow ill staff to stay

1. As part of routine practice, ask staff to regularly monitor themselves for fever and symptoms of respiratory

1. Remind staff to stay home when they are

1. If staff develop fever or symptoms of respiratory infection while at work, they should immediately put on a facemask, inform their supervisor, and leave the

1. Consult with your clinical and HR teams on decisions about further evaluation and return to

6. Essential medical visits:

19. Essential medical personnel (home health, hospice, therapy, lab services, etc.) should also be screened for signs and symptoms or possible exposure to COVID-19.

19. These personnel may have worked in other settings where there are active cases of COVID-19. When screening them for exposure staff should specifically inquire if they have had:

Prolonged close contact with someone who has confirmed COVID-19 without wearing appropriate PPE (gloves, mask, eye protection, and gown)

If they have had this type of exposure they should not be permitted to enter the classroom.

1. Per the CDC, prolonged close contact is exposure within 6 feet or a person with confirmed COVID-19 for 15 minutes or

COVID-19 Screening

For the safety and wellbeing of our students, if the answer to any of the following are yes, please speak with the Executive Director or supervisor. Thank you.

COVID-19 Screening Log

Returning students

Continue to follow all state and local health department guidelines.

Communities should consider the following when evaluating move-ins:

1. Guidance from state/local health departments and state licensing

2. Level of classroom transmission/cases of COVID-19 in the area around your senior living

3. Cases or symptoms present in other students or staff in your senior living Classroom.

4. The need and ability to test and/or quarantine new move-ins for 14

5. Whether the move-in is a new students or an existing students returning from a temporary stay at a health

6. The need to support local hospitals and health facilities attempting to open space in their facilities to care for COVID-19

Protocols for New Move-In / Returning Students:

1. Assess the students prior to start date according to normal policies. Consider the use of telehealth options to obtain necessary assessments and/or physician reports.

2. Screen the students upon arrival at the Classroom for all potential COVID-19 signs and symptoms, including measuring body

3. Request a COVID-19 test for the students and confirm a negative

1. If the students was previously positive and has recovered, per the CDC they should not be retested within three months after the date of onset for initial infection. In these situations, confirm in writing with the students’s

primary care provider that they are recovered and do not require retesting or further isolation precautions.

4. Screen the students for any potential recent exposure to COVID-19.

1. If the students is coming from an acute care or skilled nursing facility, confirm that there wasn’t exposure to COVID-19 while at the

19. When in doubt, request written confirmation from the acute care / skilled nursing facility that the students is safe to return / start date and is not suspected for COVID-19.

5. Do not allow the students to start dateto a shared apartment unless it is a spouse/couple.

1. If the students is requesting a shared apartment for financial or availability reasons, the students should start dateto a private unit for the first 14

19. After 14 days the students could transfer to a shared apartment assuming he/she has not displayed symptoms of COVID-19.

6. Screen newly admitted / returning students for signs and symptoms every shift for 14

7. Continue with all other restrictions on visitors, dining, activities, and social distancing.

Quarantining New Start dates / Returning Students:

Based on guidance from state and local health departments and based on how widespread COVID-19 cases are in your area, communities may feel it necessary to quarantine students at the time of start date/return:

1. Unless a confirmed negative COVID-19 test result can be obtained, limit the new start date / returning students’s contact with others for 14 days:

1. Examples of a returning students include:

1. Returning from an overnight stay outside the classroom

1. Returning from acute care setting (hospital, skilled nursing, rehab, etc.)

• A students who has left the classroom for a necessary appointment but was not gone overnight and was not potentially exposed to COVID-19 is not considered a “returning students” for the purposes of quarantine

1. Ask the students to stay in their apartment and avoid contact with other students, including for meals.

1. When staff enter the students’s apartment the students should be asked to wear a facemask – practice extended use of PPE per CDC guidelines if necessary.

1. Staff entering the apartment will wear appropriate PPE in accordance with CDC extended use guidelines. This includes a mask, gloves, and eye protection. Staff should wear a gown if close contact is

1. If at any point a students displays signs and symptoms of COVID-19 they will be immediately isolated, contact and droplet precautions implemented, medical attention will be obtained, and all other protocols

2. Continue with all other restrictions on visitors, dining, activities, and social distancing, PPE,

Returning from an ER Visit:

If an existing students is returning from a trip to the Emergency Room / Urgent Care:

1. Encourage the students to wear a facemask while out of the

2. Screen the students upon arrival at the Classroom for all potential COVID-19 signs and symptoms, including measuring body

3. Confirm that the students was not exposed to COVID-19 while in the emergency room / urgent

4. Increase the frequency of symptom checks including taking temperature of the students every shift for 14

New Move-Ins and Returning Students COVID-19 Screening

For the safety and wellbeing of our students, please confirm the following:

Culinary

1. In some states and counties health departments are recommending specific restrictions on dining and other group activities. Follow all recommendations from your health

2. It is recommended to either suspend communal dining or at a minimum limit dining to small groups with good social distancing between

3.    When suspending communal dining:

1. Serve meals directly in students apartments (i.e., tray service).

1. Follow the meal delivery / tray service

1. Ensure students who require assistance/supervision receive this during meals.

1. Spouses/couples may receive meals together in their shared

4.    Communal dining:

1. Suspend communal dining if there have been cases of COVID-19 in your classroom within the past 14

1. Again, follow your state and local health department

1. Students must remain 6 feet apart, including while seated. Students who live in the same apartment (couples, spouses, etc.) may eat together and be closer than 6 feet

1. Students must wear facemasks when entering and exiting the dining room.

1. If necessary, utilize alternative spaces to accommodate multiple small groups. This could include conference rooms, unoccupied apartments, model apartments, separate bistro areas,

1. Ensure students perform hand hygiene upon entering the dining room. Making alcohol based hand sanitizer available can help facilitate

1. Offers meal service directly in students apartments for those that choose that

1. Prioritize including students who require supervision/assistance in the small

1. If due to constraints of the classroom or non-compliance by students it is not possible to maintain appropriate social distancing and small groups, communal dining should be

Meals Service / Tray Delivery

Meals service / tray delivery should be implemented to serve meals in students apartments when:

• A students is being isolated for suspected COVID-19

• Classroom wide isolation is in place

• Or mandated by health department, medical providers, or similar authorities Procedure:

1. Students meal requests/orders should be submitted via telephone or other electronic means, rather than by going to the apartment to take orders whenever possible.

2. Staff delivering meals should not enter the apartment when delivering

1. If entering the apartment is required for caregiving purposes, this should only be done by qualified staff using appropriate

3. Meal service carts:

1. Should not be taken into students apartments at any

1. Should be assigned to specific areas of the classroom (e.g., AL, memory care, etc.).

4. Delivering food to the apartment of a students without suspected COVID-19:

1. Perform hand hygiene and don gloves

1. Do not enter the students’s apartment when delivering meals

1. Remove gloves and repeat hand hygiene if you have contact with the students or any surfaces in their

1. Remove gloves and repeat hand hygiene after delivering

5. Delivering food to the apartment of a students with suspected or confirmed COVID-19:

1. Perform hand hygiene

1. Don PPE (gloves, gown, mask, eye protection)

1. Announce presence to students

1. Drop off food (do not enter apartment or make contact with surfaces in the apartment)

1. Take off and dispose of PPE

1. Perform hand hygiene

1. Repeat this process between each apartment of a students with suspected or confirmed COVID-19

Activities and Outings

1. Discontinue group activities that lead to close contact between

2. Students should limit their trips out of the classroom in accordance with local guidelines.

3. Cancel activities that take students outside of the classroom to public places, particularly with large gatherings, such as malls, movies, etc. (Note: this does NOT apply to students who need to leave the building for medical care such as dialysis, medical visits, etc.).

4. Students should be encouraged to wear a cloth facemask when leaving the classroom for necessary medical appointments,

5. Properly disinfect supplies between use or avoid using shared

6. Discontinue visiting activity groups, such as outside performers or

7. Discontinue family nights and similar large gatherings. Take these to an electronic format, such as a webinar or conference call to facilitate communication.

8. In some state/county health departments are recommending further restrictions on dining and other group activities. Follow all recommendations from your health

Walking / Time Outside

While we want to ensure social distancing and protect our students from exposure to the virus, we also want to find ways to maintain overall physical and psychosocial health.

Please consider the following when incorporating walks or time outdoors into the plan of care:

1. Coordinate/schedule outdoor time to minimize the number of students and facilitate social

2. Students should always maintain social distancing. Students should not walk or sit with others. One exception to this would be a couple who already live in the same

3. Ask/encourage the students to wear a face mask if able to do

1. If the students is asymptomatic a cloth/homemade facemask is

1. If the students is symptomatic, they should wear a surgical face

4. If the students requires physical assistance or supervision, an appropriate staff member should be present to assist. The staff member should wear a face

5. Include benches and other frequently touched outdoor surfaces in your routine cleaning and disinfection

6. Ask/encourage students to perform hand hygiene before and after spending time outside of their apartment.

7. Walks should occur in controlled areas of the classroom, not in the general public.

Environmental Cleaning and Disinfection

1. Routinely clean and disinfect frequently touched surfaces (e.g., doorknobs, light switches, countertops) with the cleaners typically

2. Clean and disinfect dining areas between meals (if/when dining rooms are still in use).

3. Use an appropriate EPA-registered disinfectant. More information on disinfectants is available here:

https://www.epa.gov/pesticide-registration/list-n-disinfectants-use-against-sars- cov-2

4. Use all cleaning products according to the directions on the

5. Management of laundry, food service utensils, and medical waste should also be performed in accordance with routine

Personal Protective Equipment

1. Facemasks

1. Staff should wear a facemask at all times while they are in the classroom, including in breakrooms or other spaces where they might encounter co- workers.

1. In accordance with CDC extended use guidelines, staff should wear the same facemask through their entire shift, unless it becomes damaged or soiled.

2. N95 Respirators

19. Per the CDC: N95 respirators are recommended during contact with individuals with suspected or known COVID-19.

1. If an N95 respirator is not available, both the students and staff member should wear a surgical mask during the

3. Cloth Face Coverings

1. Students should wear a cloth face covering when outside of their apartment or around other students, staff, or

1. Visitors (when approved) should wear a cloth face covering while in the classroom or on the

4. Gloves should be used in accordance with standard

5. Gowns and eye protection should be used in accordance with contact and droplet

6. Donning (putting on) full personal protective equipment:

1. Identify and gather the proper PPE to don. Ensure choice of gown size is correct (based on training).

1. Perform hand hygiene.

1. Put on isolation gown. Tie all of the ties on the gown. Assistance may be needed by other personnel.

1. Put on N95 filtering facepiece respirator or higher (use a facemask if a respirator is not available). If the respirator has a nosepiece, it should be fitted to the nose with both hands, not bent or tented. Do not pinch the nosepiece with one hand. Respirator/facemask should be extended under chin. Both your mouth and nose should be protected. Do not wear respirator/facemask under your chin or store in scrubs pocket between students.

1. Respirator: Respirator straps should be placed on crown of head (top strap) and base of neck (bottom strap). Perform a user seal check each time you put on the

1. Facemask: Mask ties should be secured on crown of head (top tie) and base of neck (bottom tie). If mask has loops, hook them appropriately around your

1. Put on face shield or goggles. When wearing an N95 respirator or half facepiece elastomeric respirator, select the proper eye protection to ensure that the respirator does not interfere with the correct positioning of the eye protection, and the eye protection does not affect the fit or seal of the respirator. Face shields provide full face coverage. Goggles also provide excellent protection for eyes, but fogging is

1. Put on gloves. Gloves should cover the cuff (wrist) of

1. You may now enter students

7. Doffing (removing) full personal protective equipment:

1. Remove gloves. Ensure glove removal does not cause additional contamination of hands. Gloves can be removed using more than one technique (e.g., glove-in-glove or bird beak).

1. Remove gown. Untie all ties (or unsnap all buttons). Some gown ties can be broken rather than untied. Do so in gentle manner, avoiding a forceful movement. Reach up to the shoulders and carefully pull gown down and away from the body. Rolling the gown down is an acceptable

Dispose in trash receptacle. *

1. You may now exit students

1. Perform hand hygiene.

1. Remove face shield or goggles. Carefully remove face shield or goggles by grabbing the strap and pulling upwards and away from head. Do not touch the front of face shield or

1. Remove and discard respirator (or facemask if used instead of respirator). Do not touch the front of the respirator or *

1. Respirator: Remove the bottom strap by touching only the strap and bring it carefully over the head. Grasp the top strap and bring it carefully over the head, and then pull the respirator away from the face without touching the front of the

1. Facemask: Carefully untie (or unhook from the ears) and pull away from face without touching the

1. Perform hand hygiene after removing the respirator/facemask and before putting it on again if your workplace is practicing

1. In some cases under extended use or cohorting, your facemask/respirator and eye protection may be worn throughout the entire

8. See other procedures in this plan regarding specific times to utilize PPE, including students with symptoms, confirmed cases of COVID-19, and staff with symptoms.

9. Put a trash can near the exit inside the students room to make it easy for staff to discard PPE prior to exiting the room, or before providing care for another students in the same

10. Be prepared to implement CDC extended use guidelines in the section of this plan labeled “PPE: Shortages / Optimizing Supply”

11. Full procedures for the use of PPE can be viewed on the CDC website: https://www.cdc.gov/coronavirus/2019-ncov/infection-control/control-html

Fit Testing of N95 Respirators

If a staff member is required to wear an N95 respirator CDC guidance and OSHA regulations require they have a medical evaluation and be fit tested. A fit test tests the seal between the respirator facepiece and the wearer’s face. This normally must be tested for each manufacturer, model and size of respirator and must be retested annually. Fit testing takes about fifteen to twenty minutes to complete and requires specialized equipment.

You can learn more about normal fit test procedures here:

• OSHA Fit Testing Video: https://www.osha.gov/SLTC/respiratoryprotection/training_videos.html

• CDC Fit Testing Information:

https://blogs.cdc.gov/niosh-science-blog/2020/03/16/n95-preparedness/

Fit Testing During Infectious Disease Outbreaks

As the use of N95 respirators is not common in most senior living communities it is possible you may not have previously completed fit testing with your staff. Additionally, as the availability of respirators is limited nationally, even if you have previously fit tested, you may not have access to the same manufacturer, model, and size of respirators.

The CDC has published strategies to achieve the best respirator fit during a crisis. You can view the full strategies here: https://blogs.cdc.gov/niosh-science-blog/2020/04/01/fit- testing-during-outbreaks/

OSHA has issued an enforcement memo on March 14, 2020 and a further clarifying memo on April 8, 2020 that recognize the challenges related to fit testing and access to PPE during the COVID-19 pandemic. The memos state in part, “OSHA field offices will exercise enforcement discretion concerning the annual fit-testing requirements, as long as employers have made good-faith efforts to comply with the requirements of the

Respiratory Protection standard.” Communities should make every effort possible comply with the fit testing requirements and document those efforts.

Medical Evaluation

1. Prior to initial use, medical evaluations shall be provided to employees required to use a

2. Additional medical evaluations are required under any of the following circumstances:

1. If an employee reports medical signs or symptoms related to ability to use respirator

1. If the physician or other licensed healthcare provider, program administrator, supervisor recommends reevaluation

1. If information from the respirator program, including observations made during fit testing and program evaluation, indicates a need

1. If a change occurs in workplace conditions that may substantially increase the physiological burden on an

3. The medical evaluation will be in accordance with OSHA standards and may be completed a physician or other licensed healthcare professional, such as a registered nurse or physician’s

4. Medical evaluations should be completed at the time of hire for new employees, and as soon as possible for existing employees at the time this policy was implemented.

5. If the employee does not pass the medical evaluation, they will not be able to wear a respirator and should not be assigned to provide service to or around COVID-19 positive

Fit Testing

1. After receiving medical clearance, the employee must pass a respirator fit

2. Fit testing should be performed before initial use of a respirator, annually thereafter, and whenever conditions (such as employee’s physical condition) change that could affect respirator

3. Waiting for the availability of fit testing equipment should not delay the use of N95 respirators when caring for students with active COVID-19.

4. Only individuals who have received appropriate training may conduct the fit testing.

5. The fit test shall be administered using the OSHA-accepted protocol found in Appendix A in 29 CFR 1910.134, the OSHA respirator

6. Fit testing requires the respirator user to handle the respirator, have it fitted properly, test the face piece-to-face seal, and to wear it in normal air for a familiarity

7. The fit test must be performed using the same make, model, style, and size respirator the employee will

Respirator Training – Key Points

All employees will receive training before using a respirator. Training will include the key points:

1. The respirator should fit over your nose and under your chin. If you cannot get a good face seal, try a different model or

2. Facial hair will cause the respirator to leak, so users should be clean-

shaven. Some types of facial hair are acceptable as long as the facial hair does not lie along the sealing area of the respirator.

3. Practice putting on the respirator and doing a user seal check at least several times. You can view a video from OSHA on user seal checks here: https://www.youtube.com/watch?v=pGXiUyAoEd8

4. Check the fit in a mirror or ask a colleague to look to be sure the respirator is touching your face and appears to be on

5. While fit testing is ideal to confirm if a respirator does or does not fit, healthcare professionals should be able to obtain a good fit if they have had training and they perform a user seal check prior to each use of the

In addition to a user seal check, properly donning the respirator in the first place will help to achieve a good fit. Here are some additional considerations when donning your respirator:

1. Place the respirator over your nose and under your chin. If the respirator has two straps, place one strap below the ears and one strap above. If you’re wearing a hat, it should go over the straps.

2. If the respirator has a nose clip (a thin metal bar at the top of the device), use your fingertips from both hands to mold the nose clip firmly against your nose and face. Do not pinch with one

3. Be sure to conduct a user seal check every time you put on the respirator. This should be done before you enter a students room. Your respirator may have instructions on how to conduct a user seal

4. If you feel dizzy, lightheaded, or nauseated, leave the patient room, remove your respirator, and get medical

5. Discard the respirator when:

1. it becomes more difficult to breathe through it,

1. if it becomes dirty or

1. the respirator becomes

6. Do NOT TOUCH the front of the respirator! It may be

7. Keep your respirator clean and dry. Be sure to read and follow the manufacturer’s recommendations on use and

8. Follow CDC guidelines for extended use described in this

PPE Shortages / Optimizing Supply

If PPE is in limited supply, the CDC has made recommendations for optimizing the supply. You can view the full CDC recommendations here: https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/index.html

These procedures should be implemented only as needed based on available supply of PPE to meet the demand and should be tailored to each piece of PPE as necessary. Whenever possible, continue to follow normal standard, contact, and droplet precaution protocols related to PPE use. Always follow guidelines from state licensing agencies and state/local health departments.

Recommendations are generally listed in order that they should be considered, from contingency planning to crisis capacity.

1. General Recommendations

1. Do not use PPE unnecessarily. Select and use PPE based on the precautions being implemented and the specific students care task being performed.

1. Reduce students contact to only necessary care/tasks to avoid unnecessary use of

1. Prohibit visitors unless necessary for medical care to avoid unnecessary use of

1. Check with your local health department to access any backup supplies of PPE that may be

1. Reach out to nearby medical providers who are not seeing patients during the pandemic, such as dentist offices and elective surgery centers to see if PPE is

2.    Masks

1. Implement extended use of

1. Extended use of facemasks is the practice of wearing the same facemask for repeated close contact encounters with several different patients, without removing the facemask between patient encounters.

1. The facemask should be removed and discarded if soiled, damaged, or hard to breathe

• HCP must take care not to touch their facemask. If they touch or adjust their facemask they must immediately perform hand

1. HCP should leave the students care area if they need to remove the facemask.

1. Crisis Capacity: Implement limited re-use of

1. Limited re-use of facemasks is the practice of using the same facemask by one staff member for multiple encounters with different students but removing it after each encounter. As it is unknown what the potential contribution of contact transmission is for SARS-CoV-2, care should be taken to ensure that staff do not touch outer surfaces of the mask during care, and that mask removal and replacement be done in a careful and deliberate manner.

1. The facemask should be removed and discarded if soiled, damaged, or hard to breathe

• Staff should leave students care area if they need to remove the facemask. Facemasks should be carefully folded so that the outer surface is held inward and against itself to reduce contact with the outer surface during storage. The folded mask can be stored

between uses in a clean sealable paper bag or breathable container.

1. Crisis Capacity: Prioritize facemasks for selected activities such as:

1. During care activities where splashes and sprays are anticipated

1. During activities where prolonged face-to-face or close contact with a potentially infectious patient is unavoidable

• For performing aerosol generating procedures, if respirators are no longer available

1. Crisis Capacity: When no facemasks are available:

1. Use a face shield that covers the entire front (that extends to the chin or below) and sides of the face with no

1. Use of homemade masks: In settings where facemasks are not available, staff might use homemade masks (e.g., bandana, scarf) for care of students with COVID-19 as a last resort. However, homemade masks are not considered PPE, since their capability to protect HCP is unknown. Caution should be exercised when considering this option. Homemade masks should ideally be used in combination with a face shield that covers the entire front (that extends to the chin or below) and sides of the

3.    Gowns

1. Use cloth gowns that can be laundered and

1. Crisis Capacity: Don and wear the same gown for use with multiple students with confirmed or suspected COVID-19 unless the PPE becomes visibly soiled or

1. This practice should be avoided if any students are suspected or confirmed to have a co-infection that is transmitted by contact (such as C. Diff.).

1. Crisis Capacity: Reuse isolation gowns unless they become visibly soiled or

1. Crisis Capacity: If there are shortages of gowns, they should be prioritized for:

1. Aerosol-generating procedures

1. Care activities where splashes and sprays are anticipated

• High-contact patient care activities that provide opportunities for transfer of pathogens to the hands and clothing of HCP. Examples include:
  1. dressing
  2. bathing/showering
  3. transferring
  4. providing hygiene
  5. changing linens
  6. changing briefs or assisting with toileting
  7. device care or use
  8. wound care

1. Crisis Capacity: When no gowns are available:

1. Lab coats

1. Reusable (washable) patient gowns

• Disposable aprons

1. Combinations of clothing, such as long sleeve aprons, painting smocks/coveralls, or other

1. Although not included in the CDC recommendations, some health care providers have used disposable trash bags in place of

4.    Eye Protection

1. Don and wear eye protection for the entire shift unless the PPE becomes visibly soiled or

1. Staff should take care not to touch their eye protection. If they touch or adjust their eye protection they must immediately perform hand hygiene.

1. Staff should leave students care area if they need to remove their eye

1. Shift eye protection supplies from disposable to re-usable devices (i.e., goggles and reusable face shields) that can be cleaned and

1. Crisis Capacity: Prioritize eye protection for selected activities such as:

1. During care activities where splashes and sprays are anticipated, which typically includes aerosol generating

1. During activities where prolonged face-to-face or close contact with a potentially infectious students is

1. Although not included in the CDC recommendations, some providers report using regular eyeglasses or safety glasses when no other options for eye protection are

If a Students Has Symptoms

If you believe someone has COVID-19 seek medical attention and report immediately to your health department.

Students should be monitored for signs and symptoms of respiratory infection on at least a daily basis. If a students displays symptoms of respiratory illness:

1. Isolate the students in his/her apartment and limit contact as much as

1. Anyone entering the apartment must follow standard, contact, and droplet precautions.

1. Isolation includes providing meal service / tray delivery for all

2. Implement standard, contact, and droplet precautions. This includes the use of appropriate personal protective equipment, including gloves, disposable gown, mask, and eye protection anytime staff enter the apartment of otherwise have contact with the students.

3. Seek immediate medical care and inform them of the students’s condition and symptoms. Ask the students’s medical provider to determine if testing is necessary and to confirm any additional precautions that should be followed pending

4. If the students must leave their apartment (such as to be transported to medical care) they should wear a

5. The students must remain in isolation until they are either transferred to a higher level of care or confirmed by a medical provider to be negative for COVID-19.

6. Increase the frequency of temperature and symptom checks for this students to at least once per shift (three times per day).

7. Continue to follow all other precautions already in place regarding visitors, activities, dining, etc.

8. Contact the health department and follow all

Confirmed COVID-19 – Students(s)

If one or more students in the classroom are diagnosed with COVID-19:

1. Notify the health department and the students’s physician and follow all directions.

2. Students who are COVID-19 positive must isolate to his/her apartment. If they must leave the apartment for any reason (such as for medical care) they should wear a mask and avoid contact with

1. Follow standard, contact, and droplet

1. Place a sign on the door of any students who is under

1. Keep the apartment door

19. Place students(s) on alert monitoring/charting every shift until cleared of COVID-19.

1. Anyone entering the apartment of a students with confirmed COVID-19 must utilize full PPE, including:

1. Gloves
2. Gown – If gowns are being subject to extended use, they must not be re-used between confirmed COVID-19 diagnosed students and other

• N95 or higher-level respirator (or facemask if a respirator is not available)

1. Eye protection

1. Ensure PPE and hand sanitizer is readily available to persons entering the apartment and that it is disposed of or stored

1. It can be helpful to store the PPE and hand sanitizer in a small cart such as the one below right outside the apartment of any students who is being quarantined/isolated:

1. If you have students who attempt to get in the cart (such as in memory care) you may be able to secure it using “child locks” or it may be necessary to store the PPE in a more secure

• Place trash can with a lid inside the apartment for disposal of PPE prior to exiting the

1. Follow CDC extended use guidelines for PPE as described in this plan as necessary.

3. Encourage all other students to self-quarantine in their apartments (to the extent possible) except for medically necessary

1. If they leave their apartment, students should wear a facemask, perform hand hygiene, limit their movement in the classroom, and perform social distancing (stay at least 6 feet away from others).

1. Suspend communal dining and

4. If possible, assign dedicated staff to care for COVID-19 positive

5. Cohorting – If necessary/possible, consider groupings students with COVID-19 together in a dedicated area of the classroom. See the cohorting plan section for more

6. Memory Care: As it may be challenging to restrict students to their

rooms, implement universal use of eye protection and N95 or other respirators (or facemasks if respirators are not available) for all personnel when on the unit to address potential for encountering a wandering students who might have COVID-19.

7. If a students requires a higher level of care or you cannot fully implement all recommended precautions, the students should be transferred to an appropriate medical

8. Increase screening/monitoring all students and staff for signs and symptoms when there are active cases of COVID-19 in your classroom:

1. Screen students for symptoms on each

1. When there are active cases of COVID-19 in the classroom, any significant change in baseline status in a students should be evaluated for COVID-19

1. Screen staff at the start of each shift, and again at the end of each

9. Continue to follow all other precautions already in place regarding visitors, masks, hand hygiene, social distancing,

10. Initiate a COVID-19 Line List for tracking

11. Notify all staff, students, and family/responsible

12. Notify your state licensing agency as

13. Continue these precautions until advised to discontinue by the health department. Typically, this will be for at least 14

Clearing Students with COVID-19 from Transmission- Based Precautions

The following protocols will be followed to remove a students from isolation precautions due to being COVID positive:

1. Students with mild to moderate illness:

1. At least 24 hours have passed since last fever without the use of fever- reducing medications and symptoms (e.g., cough, shortness of breath) have improved

and

1. At least 14 days have passed since symptoms first appeared

2. If the students did not have any symptoms:

1. 14 days have passed since the date of their first positive COVID-19 diagnostic test, assuming they have not subsequently developed symptoms since their positive

3.    Students with severe to critical illness or who is severely immunocompromised:

1. At least 24 hours have passed since last fever without the use of fever- reducing medications and symptoms (e.g., cough, shortness of breath) have improved

and

1. At least 20 days have passed since symptoms first appeared

4. Per the CDC, except for rare situations, a test-based strategy is no longer recommended to determine when to discontinue Transmission-Based

Precautions. Follow the guidance provided by the health department and/or the students’s physician.

5. When released from isolation the students’s apartment and belongings will be cleaned and disinfected using an EPA-approved

6. If the students was placed in COVID-19 cohort unit, his/her belongings will be cleaned and disinfected before being returned to their normal apartment/unit.

7. The criteria to remove students from isolation and transmission-based precautions will be confirmed with the health department and/or the students’s physician.

Cohorting

If necessary/possible, consider grouping students with suspected or confirmed COVID- 19 together in a dedicated area of the classroom.

The goal of cohorting is to minimize interaction of infectious individuals with non- infectious individuals as much as possible. Cohorting may be particularly necessary when they are active cases in memory care.

1. The ability to cohort will be based on several factors, including:

1. The physical space and layout of your

1. Having sufficient staff to dedicate to a cohort unit/space.

1. Having sufficient supplies of personal protective equipment

1. Having sufficient equipment and supplies to dedicate to the cohort

2. The Cohort Unit

1. The cohort unit/area (also called an isolation unit) should be a separate, well-ventilated area

1. Ideally the cohort unit will have a separate

1. Minimize traffic in/out of the cohort

1. Identify areas/apartments that could be used to create separate wings, floors, or

1. With licensing/state approval, single occupancy rooms could be used as double occupancy in the cohort

1. Communities with separate cottages or “pods” could dedicate one for use as cohort space.

1. Dedicate rooms/apartments in the cohort unit for staff breaks, supplies, medication storage, etc.

3. Staffing

1. Staffing assignments should be assigned to that area

1. This includes care staff as well as ancillary staff, such as housekeeping, dining, and maintenance.

1. These staff should not work in any other part of the classroom or in other senior living communities or health care

1. Consider the use of pay or other incentives for staff working in the cohort unit.

4. Personal Protective Equipment

1. Follow standard, contact, and droplet precautions for all students in the cohort unit.

1. Ensure availability of sufficient PPE, including N95 respirators, gloves, eye protection, and

1. Follow CDC guidance for extended use of PPE if

5. Equipment and supplies (e.g., blood pressure cuffs, wheelchairs, lifts, etc.) should be assigned/dedicated to the

6. Limit visitors to only essential visits in accordance with current COVID-19 visitation

Confirmed COVID-19 – Staff

If one or more staff members are diagnosed with COVID-19:

1. Contact the health department immediately and follow all

2. Follow all directions from the health department and the employee’s

3. The employee should not return to work until medically cleared to

4. Restrict students (to the extent possible) to their apartments except for medically necessary

1. If they leave their apartment, students should wear a facemask, perform hand hygiene, limit their movement in the facility, and perform social distancing (stay at least 6 feet away from others).

5. Increase screening/monitoring all students and staff for signs and symptoms when there are active cases of COVID-19 in your classroom:

1. Screen students for symptoms on each

1. When there are active cases of COVID-19 in the classroom, any significant change in baseline status in a students should be evaluated for COVID-19

1. Screen staff at the start of each shift, and again at the end of each

6. Continue to follow all other precautions already in place regarding visitors, activities, dining, etc.

7. Initiate a COVID-19 Line List for tracking

8. Notify all staff, students, and family/responsible

9. Notify your state licensing agency as

10. Continue these precautions until advised to discontinue by the health department.

COVID-19 Line List

Please list all students AND staff members with COVID-19 respiratory symptoms.

Staff Returning to Work Criteria

The following protocols will be followed to allow an employee to return to work after being COVID positive:

1. Always follow any guidance given by your health

2. The staff member should not remain in the classroom with suspected or confirmed COVID-19.

3. The CDC does not recommend retesting staff who were previously positive to clear them to return to work. Rather, it is recommended to use the criteria

4. Confirmed positive with mild to moderate illness – may return when:

1. At least 10 days have passed since symptoms first appeared and

1. At least 24 hours have passed since last fever without the use of fever- reducing medications and

1. Symptoms (e.g., cough, shortness of breath) have improved

5. Confirmed positive but have not had any symptoms– may return when:

1. At least 10 days have passed since the date of their first positive COVID- 19 diagnostic test assuming they have not subsequently developed symptoms since their positive

6. Confirmed positive with severe to critical illness – may return when:

1. At least 20 days have passed since symptoms first appeared and

1. At least 24 hours have passed since last fever without the use of fever- reducing medications and

1. Symptoms (e.g., cough, shortness of breath) have improved

7. Staff who are severely immunocompromised should use the 20 day criteria when determining return to

When the individual returns to work, they should:

1. Wear a facemask at all times while in the classroom until all symptoms are completely resolved or until 14 days after illness onset, whichever is

2. Be restricted from contact with severely immunocompromised students (e.g., transplant, hematology-oncology) until 14 days after illness

3. Adhere to hand hygiene, respiratory hygiene, and cough etiquette in CDC’s interim infection control guidance (e.g., cover nose and mouth when coughing or sneezing, dispose of tissues in waste receptacles).

4. Self-monitor for symptoms and seek re-evaluation from occupational health if respiratory symptoms recur or

5. Continue to follow all other precautions already in place regarding screening, visitors, activities, dining,

Staff Exposure to COVID-19

As the COVID-19 pandemic progresses, staffing shortages are anticipated. These guidelines are intended to provide solutions to help alleviate potential shortages and ensure the availability of staff to serve seniors.

These recommendations are based on CDC guidelines that can be viewed here:

https://www.cdc.gov/coronavirus/2019-nCoV/php/risk-assessment.html https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-risk-assesment-hcp.html

State guidelines vary. Confirm these recommendations with your state or county health department if unsure.

1.    Prolonged Close Contact

If the staff member had prolonged close contact with a person with diagnosed COVID-19, they should be excluded from work for 14 days after last exposure or tested and seek appropriate medical care.

1. Prolonged close contact is defined by the CDC as being within 6 feet of a person with COVID-19 for at least 15 minutes without wearing proper PPE.

2.    No Close Contact and Asymptomatic

1. If a staff member has had low risk exposure with suspected COVID-19 (not close contact) and the staff member is asymptomatic:

1. Unless directed otherwise by the health department or other health professional, the staff member may continue to

1. The staff member should take appropriate precautions until 14 days after exposure, including:

1. Wear a facemask while at

2. Screen/monitor for symptoms at least twice a day and at the beginning of every shift.

3. If possible, assign the staff member to duties that do not involve direct students

• If the staff member develops symptoms consistent with COVID-19 they should immediately stop work, isolate at home, and seek medical

3.    Working in Another Classroom/Facility with COVID-19

If an employee who works in another senior living classroom/health facility that has active cases of COVID-19 and the employee is being exposed to COVID-19 in that classroom:

1. Always defer to guidance from your local health

1. If COVID-19 is confirmed and the employee continues to work at the other location, the employee should not return to your classroom until that outbreak has cleared and the employee is cleared to return to work our classroom.

1. If COVID-19 is confirmed and the employee chooses to no longer work at the other classroom, the employee may continue working at your classroom when cleared (e.g., 14 days, testing, public health confirmation, etc.).

4.    Lives with Someone with Confirmed COVID-19

If an employee lives with someone who has confirmed COVID-19, the employee should not return to work until:

1. The person they live with is cleared of COVID-19 precautions/isolation

1. They change their living arrangements to no longer live with the person who is COVID-19

After either option a or b above, they must either be cleared with a negative COVID-19 test or wait the 14-day quarantine period before returning to work.

As always, defer to any guidance provided by your local health department.

COVID-19 Testing

Testing for COVID-19 should be done based on guidance from your public health departments and students’ physicians/primary care providers. At no time should classroom staff attempt to make a diagnosis.

Testing should be implemented in addition to existing infection prevention and control measures recommended by CDC, including visitor restriction, cessation of communal dining and group activities, monitoring all staff and students for signs and symptoms of COVID-19, and universal masking as source control.

What Type of Test?

Testing for current infection requires a “viral test.” Viral tests (nucleic acid or antigen tests) check samples from the respiratory system, such as a swab from the inside of the nose, to determine if the person currently has an infection with SARS-CoV-2, the virus that causes COVID-19. Some tests are point-of-care tests, meaning results may be available at the testing site in less than an hour. Other tests must be sent to a laboratory to analyze, a process that takes 1–2 days once received by the lab. The CDC does not recommend using antibody testing alone for diagnostic purposes.

Who Should be Tested?

Always follow guidance from your health department regarding how to prioritize testing. According to the CDC, the priority for testing are staff or students with symptoms and persons identified as part of an outbreak cluster by the public health department. All recommendations for testing are based on the capacity of available testing.

1. Highest Priority for Testing
   • Staff with symptoms
   • Students with symptoms

2. Second Priority for Testing
   • New move-ins

• Existing students returning from an overnight staff in a hospital or skilled nursing facility
• Staff or students who have had prolonged close contact (within 6 feet) with someone with confirmed COVID-19, if recommended by the health department or
• Persons identified by the public health department

Classroom-Wide Testing of All Staff and Students

Some health departments or healthcare providers may recommend testing of all students and staff in the classroom. This is most often done in response to confirmed cases in the classroom or as part of a surveillance program. The health department or healthcare providers should help the classroom determine who should be tested.

Repeat Testing: After initial testing has been performed for students and staff (baseline) and the results have been used to implement students isolation/cohorting and staff work exclusions, health departments or medical professionals may recommend retesting. Follow all guidance provided regarding who, when, and how often to retest.

Per the CDC, for persons previously diagnosed with COVID-19 who remain asymptomatic after recovery, retesting is not recommended within 3 months after the date of onset for the initial COVID-19 infection.

Collecting Testing Specimens

The CDC recommends using an upper respiratory specimen. Confirm with the lab providing the testing kits which of the following should be used:

• Nasopharyngeal
• Oropharyngeal
• Nasal mid-turbinate swab
• Anterior nares (nasal swab)

The nasal swab is generally the least invasive and easier specimen collection method.

It is preferred that the health department assist with collecting samples. That may not always be possible. If it is determined that test samples will be collected by classroom staff, consider these additional precautions:

1. You will need an MD or other authorized prescriber to sign off on the test order/requisition.

2. Test samples should only be collected by an appropriately

1. Anterior nares (nasal swab) specimens may be collected nurses, med techs, or similarly qualified individuals with appropriate training. These individuals must be trained by a nurse or other appropriately licensed professional. Poor specimen collection technique can contribute to inaccurate test results. Always document

1. Anterior nares specimens can also be self-collected when necessary and appropriate.

1. All other specimens should be collected by an appropriately licensed professional (e.g., nurse).

3. Request instructions from the lab providing your test kits and follow those instructions.

4. Use the line list form to track tests collected/submitted.

5. Collecting swabs/samples:

1. Staff taking the testing sample should be in appropriate PPE (gloves, gown, N95 respirator, eye protection)

1. If collecting multiple samples, consider using at least two staff members to setup a “clean/dirty” system. This may not be necessary when only collecting one or a small number of samples. The purpose of this system is to improve efficiency, infection control, and use of

1. The “clean” tester never approaches the students/employee.

1. The Clean tester opens the test tube/swab kit, labels it, and hands the swab to the “Dirty”

• The Dirty tester collects the sample from the students/employee, puts the swab into the test tube, seals it, and then returns it to a bag being held by the Clean

1. Repeat the process until all samples

6. Swabs/samples may need to be stored in a refrigerator until returned to the lab for processing. Confirm with the instructions provided by the

7. Return samples to the lab for processing

8. Coordinate with the lab and MD/PCP to receive and interpret results. Classroom staff should not attempt to interpret a test result and/or make a

Nasal Swab (Anterior Nares) Specimen Collection

Follow these procedures to collect a shallow nasal (anterior nares) specimen for

COVID-19 diagnostic testing. A short training video on this procedure can be viewed at: https://vimeo.com/436943467/b66cddb48a

1. Follow any instructions provided by the lab or health department and prepare all paperwork and

2. Perform hand hygiene and don PPE, including gown, N95 respirator, eye protection, and

3. Ask the individual to blow their

4. Use a single swab for collecting specimens from both

5. Insert swab at least 0.5 inch into the nostril. Stop if you feel resistance.

6. Once the swab is in place, rotate it in a circular keeping in place for 10-15

7. Repeat this step for the second nostril using the same

8. Remove swab and insert the swab into the transport tube provided by the Be cautious not to touch the swab to any other surfaces.

9. Ensure the tube is properly labeled and return to the lab with all necessary paperwork.

Staffing Backup Plan

COVID-19 can lead to staffing shortages due to staff refusing to work or when doing classroom wide testing of all staff, this could lead to staffing challenges when employees must stay away from work for 10 or more days due to positive tests.

Alternate staffing plans must be based on the needs of each classroom, but can include:

1. Recruiting and hiring additional

2. Reassigning managers to direct care/support roles.

3. Use of agency staffing. Secure agreements with staffing agencies in advance, and confirm they are willing/able to work in communities with COVID-19 positive students.

4. Pay or other incentives for staff who continue

5. Alternative work schedules, such as 12-hour shifts or extended work Ensure state and federal overtime pay rules are followed.

6. Cancelling non-essential services and reassigning those staff to support students care.

7. Use of cohorting of COVID-19 positive students (see cohorting plan for more information).

8. Consider using CDC criteria that allow to staff with suspected or confirmed COVID-19 (who are well enough to work) to return to work. This should only be done in the case of extreme crisis staffing shortages and should be discussed with the health department in

9. Consider relocation of students to alternate communities or facilities if necessary.

Shelter in Place

THIS ONLY APPLIES TO THE LIMITED AREAS IN THE COUNTRY WITH SHELTER IN PLACE ORDERS IN EFFECT.

If you state or county implements a “shelter in place” or “stay at home” order that restricts the public to staying in their homes and/or limited use of public services, we recommend:

1. Follow all directions from your county notice and your health

2. Immediately communicating with staff in communities impacted by these orders to ensure they understand that they may continue coming to

3. Provide your staff with identification or other information that they can present to authorities if needed to ensure they will be allowed to continue to work. Attached is a sample letter that can be modified and printed on company letterhead to assist with this.

[DATE]

TO:            Whom it May Concern FROM:                  [NAME OF ED]

Executive  Director [NAME OF CLASSROOM]

RE:           Shelter in Place

Dear Sir or Madam,

This letter is to confirm that:

[NAME OF EMPLOYEE]

Is an essential employee of a licensed proprietary school. It is essential he/she be at work to provide care and services for our students, and should be allowed to continue to work at:

[NAME OF CLASSROOM] [ADDRESS]

[CITY, STATE, ZIP] [LICENSE NUMBER] [PHONE NUMBER]

Thank you,

[NAME OF ED]

18. Frequently clean often-touched surfaces, especially in hallways and common areas where students and staff spend a lot of

19. Activities

1. Continue to provide structured activities, which may need to occur in the students’s room or be scheduled at staggered times throughout the day to maintain social

23. Follow all directions from your public health department.

Training Webinar Videos

The following training videos may be used to aid in staff training. Always ensure you are following the latest CDC, health department, and state licensing guidelines!

The videos can be played on any internet connect device, including tablets and mobile phones.

• COVID-19 Introduction and Overview https://vimeo.com/400768570/0b8824ca75

• COVID-19 Standard, Contact, and Droplet Precautions https://vimeo.com/400775922/7fd755b759

• COVID-19 Personal Protective Equipment (Includes CDC extended use guidelines) https://vimeo.com/400788568/0fdde84d79

• COVID-19 Responding to Signs and Symptoms https://vimeo.com/400792175/7f5188337e

• CDC Hand Hygiene Video https://youtu.be/d914EnpU4Fo

Additional Resources

• AHCA/NCAL Recommendations for Nebulizer Treatments: https://www.ahcancal.org/facility_operations/disaster_planning/Documents/Nebul pdf

• CDC Checklist for Preparing the Home

(May be a helpful for staff who are wondering what to do at home) https://www.cdc.gov/coronavirus/2019-ncov/prepare/checklist-household- ready.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2 F2019-ncov%2Fclassroom%2Fhome%2Fchecklist-household-ready.html

• CDC Travel Guidelines

https://www.cdc.gov/coronavirus/2019-ncov/travelers/index.html

• EPA-Registered Disinfectants

https://www.epa.gov/pesticide-registration/list-n-disinfectants-use-against-sars- cov-2

• Collecting a Nasopharyngeal Swab https://www.youtube.com/watch?v=syXd7kgLSN8

Remember:

• PPE must be donned correctly before entering the patient area (e.g., isolation room, unit if cohorting).
• PPE must remain in place and be worn correctly for the duration of work in potentially contaminated PPE should not be adjusted (e.g., retying gown, adjusting respirator/facemask) during patient care.
• PPE must be removed slowly and deliberately in a sequence that prevents self-contamination. A step-by-step process should be developed and used during training and patient

Face shield or goggles

N95 or higher respirator When respirators are not available, use the best available alternative, like a facemask.

Face shield or goggles

Facemask

N95 or higher respirators are preferred but facemasks are an acceptable alternative.

One pair of clean, non-sterile gloves

One pair of clean, non-sterile gloves

Isolation gown                                                                                                                                                      Isolation gown

CS 316124-A 06/03/2020

www.cdc.gov/coronavirus                       

Donning (putting on the gear):

More than one donning method may be acceptable. Training and practice using your healthcare facility’s procedure is critical. Below is one example of donning.

1. Identify and gather the proper PPE to Ensure choice of gown size is correct (based on training).
2. Perform hand hygiene using hand
3. Put on isolation Tie all of the ties on the gown. Assistance may be needed by another HCP.
4. Put on NIOSH-approved N95 filtering facepiece respirator or higher (use a facemask if a respirator is not available). If the respirator has a nosepiece, it should be fitted to the nose with both hands, not bent or Do not pinch the nosepiece with one hand. Respirator/facemask should be extended under chin. Both your mouth and nose should be protected. Do not wear respirator/facemask under your chin or store in scrubs pocket between patients.*

» Respirator: Respirator straps should be placed on crown of head (top strap) and base of neck (bottom strap). Perform a user seal check each time you put on the respirator.

» Facemask: Mask ties should be secured on crown of head (top tie) and base of neck (bottom tie). If mask has loops, hook them appropriately around your ears.

5. Put on face shield or When wearing an N95 respirator or half facepiece elastomeric respirator, select the proper eye protection to ensure that the respirator does not interfere with the correct positioning of the eye protection, and the eye protection does not affect the fit or seal of the respirator. Face shields provide full face coverage. Goggles also provide excellent protection for eyes, but fogging is common.
6. Put on Gloves should cover the cuff (wrist) of gown.
7. HCP may now enter patient

Doffing (taking off the gear):

More than one doffing method may be acceptable. Training and practice using your healthcare facility’s procedure is critical. Below is one example of doffing.

1. Remove Ensure glove removal does not cause additional contamination of hands. Gloves can be removed using more than one technique (e.g., glove-in-glove or bird beak).
2. Remove gown. Untie all ties (or unsnap all buttons). Some gown ties can be broken rather than untied. Do so in gentle manner, avoiding a forceful Reach up to the shoulders and carefully pull gown down and away from the body. Rolling the gown down is an acceptable approach. Dispose in trash receptacle.*
3. HCP may now exit patient
4. Perform hand
5. Remove face shield or Carefully remove face shield or goggles by grabbing the strap and pulling upwards and away from head. Do not touch the front of face shield or goggles.
6. Remove and discard respirator (or facemask if used instead of respirator).* Do not touch the front of the respirator or

» Respirator: Remove the bottom strap by touching only the strap and bring it carefully over the head. Grasp the top strap and bring it carefully over the head, and then pull the respirator away from the face without touching the front of the respirator.

» Facemask: Carefully untie (or unhook from the ears) and pull away from face without touching the front.

7. Perform hand hygiene after removing the respirator/facemask and before putting it on again if your workplace is practicing

*Facilities implementing reuse or extended use of PPE will need to adjust their donning and doffing procedures to accommodate those practices.

www.cdc.gov/coronavirus   

Recuerde:

• Se debe tener el EPP correctamente puesto antes de entrar al área de pacientes (p. , sala de aislamiento o unidad de aislamiento en caso de cohorte).
• Se debe dejar el EPP puesto y usar de la manera correcta durante todo el tiempo que se esté trabajando en áreas potencialmente No se debe reajustar el EPP durante la atención del paciente (p. ej., volver a atar la bata, ajustar el

respirador o mascarilla).

• El EPP se debe quitar lenta y deliberadamente en una secuencia que prevenga la autocontaminación. Se debe crear un proceso paso a paso y practicarse durante la capacitación y atención del

Protector facial o gafas de protección

Respirador N95 o superior Cuando no haya respiradores disponibles, usar la mejor alternativa disponible, como una mascarilla.

Protector facial o gafas de protección

Mascarilla

Es preferible usar un respirador N95 o superior, pero las mascarillas son una alternativa aceptable.

Un par de guantes no estériles limpios

Un par de guantes no estériles limpios

Bata de aislamiento                                                                                                                                            Bata de aislamiento

www.cdc.gov/coronavirus-es   

CS 316124-A 04/28/2020

Cómo ponerse el EPP:

Podría haber más de un método aceptable para ponerse el EPP. Es crítico que se capacite en el procedimiento que se use en su establecimiento de atención médica y lo practique. A continuación se detalla un ejemplo de cómo ponerse el EPP.

1. Identificar el EPP adecuado para ponerse y reunir lo Revise que el tamaño de la bata sea el correcto (según la capacitación).
2. Higienizarse las manos con desinfectante de
3. Ponerse la bata de Ate todas las tiras de la bata. Podría necesitar la ayuda de otro miembro del personal.
4. Ponerse un respirador con mascarilla de filtrado nivel N95 o superior aprobado por NIOSH (usar una mascarilla si no hay un respirador disponible). Si el respirador tiene una banda de metal, se debe moldear a la forma de la nariz con las dos manos, no se debe arquear ni doblar por el No la pellizque con una mano. El respirador o mascarilla debe llegar hasta la parte de abajo del mentón. Deben quedar protegidas la nariz y la boca. No lleve el respirador o mascarilla por debajo del mentón ni lo guarde en el bolsillo del uniforme entre un paciente y el otro.*

» Respirador: Las bandas del respirador se deben colocar sobre la corona de la cabeza (la banda superior) y la nuca (la banda inferior). Autoverifique el sellado cada vez que se ponga el respirador.

» Mascarilla facial: Las bandas de la mascarilla se deben atar sobre la corona de la cabeza (las bandas superiores) y la nuca (las bandas inferiores). Si la mascarilla tiene cintas elásticas, colóqueselas apropiadamente detrás de las orejas.

5. Ponerse el protector facial o gafas Cuando use un respirador N95 o un respirador elastomérico con mascarilla de media cara, seleccione un protector de ojos adecuado asegurándose de que el ni el respirador interfiera en el posicionamiento correcto del protector de ojos ni el protector de ojos afecte el ajuste o el sellado del respirador. Los

protectores faciales proveen cobertura a toda la cara. Las gafas protectoras también proveen una excelente protección de los ojos, pero es común que se empañen.

6. Ponerse los Los guantes deben cubrir los puños de la bata.
7. Ahora se puede ingresar a la habitación del

Cómo quitarse el EPP:

Podría haber más de un método aceptable para quitarse el EPP. Es crítico que se capacite en el procedimiento que se use en su establecimiento de atención médica y lo practique. A continuación se detalla un ejemplo de cómo quitarse el EPP.

1. Quitarse los Asegúrese de no causar contaminación adicional a las manos al quitarse los guantes. Los guantes se pueden quitar usando más de una técnica (p. ej., con la primera mano desenguantada o envuelta en el revés del primer guante).
2. Quitarse la Desate todas las tiras (o desabroche todos los broches). Las tiras de algunas batas se deben romper en lugar de desatar. Hágalo suavemente, sin movimientos abruptos. Quítese cuidadosamente la bata desde los hombros hacia abajo y lejos del cuerpo. Enrollarla hacia abajo es un enfoque aceptable. Deséchela en un bote de basura.*
3. Ahora se puede salir de la habitación del
4. Higienizarse las
5. Quitarse el protector facial o gafas Quítese cuidadosamente el protector facial o gafas protectoras tomando la banda y jalándola hacia arriba y lejos de la cabeza. No toque el frente del protector facial o gafas protectoras.
6. Quitarse y desechar el respirador (o mascarilla, si se usó mascarilla en lugar de respirador).* No toque el frente del respirador o

» Respirador: Quítese la banda inferior tocando solo la banda y pasándosela cuidadosamente por encima de la cabeza. Tome la banda superior y pásesela cuidadosamente por encima de la cabeza, y luego retírese el respirador de la cara sin tocar el frente del respirador.

» Mascarilla: Desate las bandas (o desengáncheselas de las orejas) y retírese la mascarilla de la cara sin tocar el frente.

7. Higienizarse las manos después de quitarse el respirador o mascarilla y antes de volver a ponérselo si en su lugar de trabajo los están volviendo a

* En los establecimientos donde se esté implementando el uso

repetido o extendido de EPP los procedimientos sobre cómo

www.cdc.gov/coronavirus-es                 

ponerse y quitarse el EPP se deberán adaptar a tales prácticas.

CONTACT & DROPLET PRECAUTIONS

(In addition to Standard Precautions)

Visitors check in with staff before entering.

Everyone Must:

Use Personal Protective Equipment:

CONTACT & DROPLET PRECAUTIONS

(In addition to Standard Precautions)

Visitors check in with staff before entering.

Everyone Must:

Use Personal Protective Equipment:

Nancy Kimmel, PhD MSN FNP-BC

Nancy L. Kimmel obtained her PhD in Environmental Engineering in 2002, then went on to teach Physics and Mechanical Engineering at Lawrence Technological University, Henry Ford College and Oakland University. She obtained her Associate in Nursing from Henry Ford College and then went on to earn her Master Degree as a Family Nurse Practitioner and became Board Certified working as a licensed FNP in the State of Michigan. She then went on to Medical School where she is now in her 3rd year, and is also in the process of obtaining her Doctorate in Nursing Practice through Chamberlin University. She has authored the NET Study Guide, as well a several books on subjects of Math, ECG/EKG and Phlebotomy. She holds a patent on an Air Filter through the U.S. Patent Office.