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Guideline for COVID-19 Outbreak Prevention and Management in Northern Health Facilities (Including Acute Care and Long-Term Care Facilities)

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Guideline for COVID-19 Outbreak Prevention and Management in Northern Health Facilities (Including Acute Care and Long-Term Care Facilities) Guideline for COVID-19 Outbreak Prevention and Management in Northern Health Facilities (Including acute care and long-term care facilities) August 6, 2020 Infection Prevention & Control and Population & Public Health 1 | P a g e Guideline for COVID-19 Outbreak Prevention & Management in Northern Health Facilities Last updated: August 6, 2020 – V3.0 Table of Contents Page No. Introduction 3 Outbreak Detection and Prevention 3 Outbreak Readiness 9 Case and Outbreak Definitions 9 Initial Infection Control Procedure - flowchart 10 Outbreak Management 11 Outbreak Termination 17 Definitions 18 Key Guidance Documents 19 Please click on the Copy of form APPENDICES link to view forms on page Sample Collection July A. Specimen Collection 20 8, 2020 B. Facility Entry Screening Script 23 C. Essential Visitor Sign in Sheet Sign-in sheet 25 D. Daily Resident/patient Symptom Check 10-800-5007 26 E. Covid-19-like illness Line List for 10-800-7001 27 Resident/patients/Patients F. Covid-19-like illness Line List for Staff 10-800-7002 28 Form DCVI-100-0001f G. BCCDC Virology Requisition Form 29 Version 2.2 07/2017 H. Signage 31 Droplet & Contact Precautions Signs 10-414-6203 31 STOP - Outbreak in Progress Poster – do not visit 10-414-6181 32 BCCDC Essential visitors ONLY poster (LTC only) Essential visitors ONLY 33 NH Essential Visitor Poster 10-800-6009 34 REVISIONS Changes from the May 4, 2020 version are highlighted in yellow. Infection Prevention & Control and Population & Public Health 2 | P a g e Guideline for COVID-19 Outbreak Prevention & Management in Northern Health Facilities Last updated: August 6, 2020 – V3.0 INTRODUCTION This guideline was developed to assist Northern Health facilities to prepare, detect and respond to cases and outbreaks of COVID-19. Managing a COVID-19 outbreak can be challenging. This guideline will ensure the risk of transmission to other clients, as well as Health Care Workers, is minimized. COVID-19 is a virus that causes a respiratory and/or systemic illness ranging from common cold- like symptoms to more severe disease. Gastrointestinal symptoms may also occur, but it is less common for these to be the only symptoms. It spreads through droplet and contact transmission and requires appropriate PPE. If one resident/patient or Health Care Worker is confirmed to have COVID-19, and it is believed the infection was acquired at the facility, an outbreak will be declared by the Medical Health Officer. It is vitally important that all Health Care Workers are aware of the case definition for COVID-19 and the need to monitor for and test resident/patients with new or worsening respiratory, systemic, or gastrointestinal symptoms. This guideline includes enhanced routine preventive measures to be applied in all Northern Health facilities at all times. This guideline applies for the duration of the provincial Public Health Emergency related to COVID-19. OUTBREAK PREVENTION AND DETECTION Infection prevention and control practices All Health Care Workers must use Routine Practices (Clinical Practice Standard 1-11-1-3- 070) when caring for any resident/patient. In addition to routine practices, when a resident/patient presents with a respiratory, systemic, or gastrointestinal illness, additional precautions are necessary. All resident/patients with a new respiratory, systemic, or gastrointestinal illness need to be placed on droplet/contact precautions. Aerosol-generating medical procedures (AGMPs) N95 respirators or equivalent are only required when aerosol-generating medical procedures (AGMPs) are performed on resident/patients with suspected or confirmed respiratory infection. Examples of AGMP include nebulizers, CPAP, BiPAP, intubation and high-flow oxygen over 6 liters/min. In order to reduce the use of, and exposure to, AGMPs: o Avoid the use of nebulizers wherever possible. Respiratory medications should be delivered by an aero chamber and inhaler. o Consider reducing high-flow oxygen to maintain less than 6 liters/min. Infection Prevention & Control and Population & Public Health 3 | P a g e Guideline for COVID-19 Outbreak Prevention & Management in Northern Health Facilities Last updated: August 6, 2020 – V3.0 o If resident/patient has the cognitive and physical ability, consider having them start and stop their own CPAP/BiPAP, and delay Health Care Worker entry into the room until 90 minutes has elapsed. o Ensure a notice is posted immediately on the outside of any room where an AGMP takes place, to alert Health Care Workers and visitors an AGMP may be taking place in the room and to don appropriate PPE as required. Hand hygiene and respiratory hygiene Teach resident/patients how to perform hand hygiene and respiratory hygiene, where physically and cognitively able. Post signs and posters around the facility, including in all bathrooms, to encourage and guide clients, Health Care Workers, and visitors on proper hand hygiene and respiratory hygiene. Ensure alcohol-based hand rub with at least 70% alcohol content is readily available to clients, Health Care Workers, and visitors at all facility entry and exit points, common areas, client units, and at point-of-care in the client’s room. Ensure sinks are well-stocked with plain soap and paper towels for hand washing. Please note antibacterial soap is not required for COVID-19. Ensure other supplies, including disinfecting wipes, tissues, and lidded, non-touch waste bins are available for use by clients, Health Care Workers, and visitors, as required at point-of-use. Housekeeping In addition to routine cleaning, high touch surfaces should be cleaned twice daily. Physical distancing As much as possible, maintain distance of at least two metres (6 feet) between Health Care Workers, resident/patients, and visitors at all times. Where communal dining is provided, staggered meal times may be required to allow resident/patients to maintain this distance while dining. (LTC Only) Re-organize shared facility spaces to enable and encourage the maintenance of safe physical distance. Cancel all social activities, except where this distance can be maintained. (LTC Only) Install physical barriers, such as clear partitions at reception desks and sneeze guards in food service areas. Visitor restrictions Limit the number of entry points into the facility. Restrict visitors in accordance with current policy. Place signage at the entrance of the facility regarding visitor restrictions. Infection Prevention & Control and Population & Public Health 4 | P a g e Guideline for COVID-19 Outbreak Prevention & Management in Northern Health Facilities Last updated: August 6, 2020 – V3.0 Any visitors who does enter the facility must be screened for symptoms and must sign in on the visitor sign-in sheet (Appendix C). Retain visitor logs for four weeks, so potential contacts can be identified in the event of an outbreak. Essential visits shall be limited to one visitor per client in the facility at a time (except in the case of palliative/end of life care). Essential visitors should visit resident/patients in their rooms, rather than in common areas. All visitors must be instructed on how to practice respiratory etiquette, hand hygiene and physical distancing (i.e., maintaining at least two meters of physical distance from others at all times), and how to put on and remove a surgical/procedure mask. All visitors must be capable of complying with appropriate precautions, including infection prevention and control measures. If not, the visitor must be excluded from visiting. LTC Only Place signage (LTC) at the entrance of the facility regarding visitor restrictions. All visitors must bring and wear their own mask (can be non-medical mask) for the duration of their visit. If the visitor did not bring their own mask, one will be provided. Facility will schedule all visitation appointments. Enhanced symptom screening of all Health Care Workers, visitors, and new or returning resident/patients, upon arrival Actively screen all Health Care Workers, visitors, and service providers, as well as new and returning resident/patients (returning from family visits, day trips, appointments and those entering the facility for respite care) for respiratory, systemic, or gastrointestinal symptoms upon entry. During business hours, a Health Care Worker will be posted at all entry points to actively screen every person who enters the building for symptoms of COVID-19. Outside of regular business hours, develop, and implement a comparable process to ensure everyone entering the building is actively screened. Protect screeners by installing physical distancing supports including spacing markers on the floor (2 metres apart) and transparent barriers that prevent droplet transmission without interfering with communication between the screeners and others. Screeners should follow the Facility Entry Screening Script (Appendix B). In addition, passive screening of visitors should occur by way of signage (in multiple languages) posted at all entrances to the facility reminding persons entering the facility to NOT enter if they have symptoms such as fever, cough, difficulty breathing, chills, sore throat, runny nose, vomiting or diarrhea. It should also include clear instructions on how to perform respiratory and hand hygiene. Individuals with symptoms should not enter the facility unless under special circumstances and with the knowledge and pre-approval of the Medical Health Officer. This also applies to new admissions to LTC, which should be delayed if the person is symptomatic and COVID-19 has not been ruled out. Infection Prevention & Control and Population & Public Health 5 | P a g e Guideline for COVID-19 Outbreak Prevention & Management in Northern Health Facilities Last updated: August 6, 2020 – V3.0 If a returning resident/patient answers YES to any of the screening questions: provide resident/patient and any accompanying individual(s) a surgical/procedure mask to wear and ask them to perform hand hygiene. If they are unable to tolerate a mask, or if contact with the patient or their belongings is required, the Health Care Worker must wear a gown, mask, and eye protection.
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