Resources for Healthcare Facilities
Steps Healthcare Facilities Can Take Now to Prepare for Coronavirus Disease 2019 (COVID-19)
The true impact of a COVID-19 outbreak in a U.S. community cannot be predicted. However, all healthcare facilities can take steps now to prepare for such an outbreak and protect both their patients and staff.
Be prepared:
• Stay informed about the local COVID-19 situation. Know where to turn for reliable, up-to-date information in your local community. Monitor the CDC COVID-19 website and your state and local health department websites for the latest information.
• Develop, or review, your facility’s emergency plan. A COVID-19 outbreak in your community could lead to staff absenteeism. Prepare alternative staffing plans to ensure as many of your facility’s staff are available as possible.
• Establish relationships with key healthcare and public health partners in your community. Make sure you know about healthcare and public health emergency planning and response activities in your community. Learn about plans to manage patients, accept transfers, and share supplies. Review any memoranda of understanding (MOUs) with affiliates, your healthcare coalition, and other partners to provide support or assistance during emergencies.
• Create an emergency contact list. Develop and continuously update emergency contact lists for key partners and ensure the lists are accessible in key locations in your facility. For example, know how to reach your local or state health department in an emergency.
Communicate with staff and patients:
• Communicate about COVID-19 with your staff. Share information about what is currently known about COVID-19, the potential for surge, and your facility’s preparedness plans.
• Communicate about COVID-19 with your patients. Provide updates about changes to your policies regarding appointments, providing non-urgent patient care by telephone, and visitors. Consider using your facility’s website or social media pages to share updates.
Protect your workforce:
• Screen patients and visitors for symptoms of acute respiratory illness (e.g., fever, cough, difficulty breathing) before entering your healthcare facility. Keep up to date on the recommendations for preventing spread of COVID-19 on CDC’s website.
• Ensure proper use of personal protection equipment (PPE). Healthcare personnel who come in close contact with confirmed or possible patients with COVID-19 should wear the appropriate personal protective equipment.
• Conduct an inventory of available PPE. Consider conducting an inventory of available PPE supplies. Explore strategies to optimize PPE supplies.
• Encourage sick employees to stay home. Personnel who develop respiratory symptoms (e.g., cough, shortness of breath) should be instructed not to report to work. Ensure that your sick leave policies are flexible and consistent with public health guidance and that employees are aware of these policies.
Protect your patients:
• Stay up-to-date on the best ways to manage patients with COVID-19.
• Separate patients with respiratory symptoms so they are not waiting among other patients seeking care. Identify a separate, well-ventilated space that allows waiting patients and visitors to be separated.
• Consider the strategies to prevent patients who can be cared for at home from coming to your facility potentially exposing themselves or others to germs, like:
○ Using your telephone system to deliver messages to incoming callers about when to seek medical care at your facility, when to seek emergency care, and where to go for information about caring for a person with COVID at home.
○ Adjusting your hours of operation to include telephone triage and follow-up of patients during a community outbreak.
○ Leveraging telemedicine technologies and self-assessment tools.
Interim Guidance for Healthcare Facilities: Preparing for Community Transmission of COVID-19 in the United States
Key Considerations for Healthcare Facilities:
Currently there are no medications to treat or vaccines to prevent COVID-19. Therefore, community approaches to slowing transmission including appropriate hand hygiene, cough etiquette, social distancing, and reducing face-to-face contact with potential COVID-19 cases are needed to slow disease transmission and reduce the number of people who get sick. In each healthcare facility, the primary goals include:
• Provision of the appropriate level of medical care
• Protecting healthcare personnel and non-COVID-19 patients accessing healthcare from infection
• Preparing for a potential surge in patients with respiratory infection
• Preparing for potential personal protective equipment supply and staff shortages
Purpose of this document: This interim guidance outlines goals and strategies for all U.S. healthcare facilities to prepare for and respond to community spread of coronavirus disease-2019 (COVID-19). Although it is not possible to predict the future course of the outbreak, planning for a scenario in which many persons become ill and seek care at the same time is an important part of preparedness and can improve outcomes if an outbreak occurs. Therefore, preserving healthcare system functioning is paramount. It is critical for healthcare facilities to continue to provide care for all patients, irrespective of COVID-19 infection status, at the appropriate level (e.g., home-based care, outpatient, urgent care, emergency room, or hospitalization). Facilities may need to respond to a surge in patients requiring care. Concentrated efforts will be required to mobilize all aspects of healthcare to reduce transmission of disease, direct people to the right level of care, and decrease the burden on the healthcare system.
Public health guidance will shift as the COVID-19 outbreak evolves. All healthcare facilities should be aware of any updates to local and state public health recommendations.
Key Goals for the U.S. healthcare system in response to the COVID-19 outbreak are to:
1. Reduce morbidity and mortality
2. Minimize disease transmission
3. Protect healthcare personnel
4. Preserve healthcare system functioning
Actions to take now to prepare for an outbreak of COVID-19
1. Designate a time to meet with your staff to educate them on COVID-19 and what they may need to do to prepare. The following may be useful resources to share information about COVID-19:
○ How COVID-19 spreads
○ Clinical management of COVID-19 patients
○ Infection prevention and control recommendations for COVID-19
2. Explore alternatives to face-to-face triage and visits. The following options can reduce unnecessary healthcare visits and prevent transmission of respiratory viruses in your facility:
○ Instruct patients to use available advice lines, patient portals, on-line self-assessment tools, or call and speak to an office/clinic staff if they become ill with symptoms such as fever, cough, or shortness of breath.
○ Identify staff to conduct telephonic and telehealth interactions with patients. Develop protocols so that staff can triage and assess patients quickly.
○ Determine algorithms to identify which patients can be managed by telephone and advised to stay home, and which patients will need to be sent for emergency care or come to your facility.
○ Instruct patients that if they have respiratory symptoms they should call before they leave home, so staff can be prepared to care for them when they arrive.
3. Plan to optimize your facility’s supply of personal protective equipment in the event of shortages. Identify flexible mechanisms to procure additional supplies when needed.
4. Prepare your facility to safely triage and manage patients with respiratory illness, including COVID-19. Become familiar with infection prevention and control guidance for managing COVID-19 patients.
○ Visual alerts (signs, posters) at entrances and in strategic places providing instruction on hand hygiene, respiratory hygiene, and cough etiquette
○ Ensure supplies are available (tissues, waste receptacles, alcohol-based hand sanitizer)
○ Facemasks are available at triage for patients with respiratory symptoms
○ Create an area for spatially separating patients with respiratory symptoms. Ideally patients would be >6 feet apart in waiting areas.
Plan to Take the Following Actions if COVID-19 is spreading in your community
1. Work with local and state public health organizations, healthcare coalitions, and other local partners to understand the impact and spread of the outbreak in your area.
2. Designate staff who will be responsible for caring for suspected or known COVID-19 patients. Ensure they are trained on the infection prevention and control recommendations for COVID-19 and proper use of personal protective equipment.
3. Monitor healthcare workers and ensure maintenance of essential healthcare facility staff and operations:
○ Ensure staff are aware of sick leave policies and are encouraged to stay home if they are ill with respiratory symptoms.
○ Be aware of recommended work restrictions and monitoring based on staff exposure to COVID-19 patients.
○ Advise employees to check for any signs of illness before reporting to work each day and notify their supervisor if they become ill.
○ Do not require a healthcare provider’s note for employees who are sick with respiratory symptoms before returning to work.
○ In settings of widespread transmission, your facility may consider screening staff for fever or respiratory symptoms before entering the facility.
○ Make contingency plans for increased absenteeism caused by employee illness or illness in employees’ family members that would require them to stay home. Planning for absenteeism could include extending hours, cross-training current employees, or hiring temporary employees.
4. When possible, manage mildly ill COVID-19 patients at home.
○ Assess the patient’s ability to engage in home monitoring, the ability for safe isolation at home, and the risk of transmission in the patient’s home environment.
○ Caregivers and sick persons should have clear instructions regarding home care and when and how to access the healthcare system for face-to-face care or urgent/emergency conditions.
○ If possible, identify staff who can monitor those patients at home with daily “check-ins” using telephone calls, text, patient portals or other means.
○ Engage local public health, home health services, and community organizations to assist with support services (such as delivery of food, medication and other goods) for those treated at home.
Considerations for specific settings (In addition to above)
1. Outpatient facilities
○ Reschedule non-urgent outpatient visits as necessary.
○ Consider reaching out to patients who may be a higher risk of COVID-19-related complications (e.g., elderly, those with medical co-morbidities, and potentially other persons who are at higher risk for complications from respiratory diseases, such as pregnant women) to ensure adherence to current medications and therapeutic regimens, confirm they have sufficient medication refills, and provide instructions to notify their provider by phone if they become ill.
○ Consider accelerating the timing of high priority screening and intervention needs for the short-term, in anticipation of the possible need to manage an influx of COVID-19 patients in the weeks to come.
○ Symptomatic patients who need to be seen in a clinical setting should be asked to call before they leave home, so staff are ready to receive them using appropriate infection control practices and personal protective equipment.
○ Eliminate patient penalties for cancellations and missed appointments related to respiratory illness.
2. Inpatient facilities
○ Reschedule elective surgeries as necessary.
○ Shift elective urgent inpatient diagnostic and surgical procedures to outpatient settings, when feasible.
○ Limit visitors to COVID-19 patients.
○ Plan for a surge of critically ill patients and identify additional space to care for these patients. Include options for:
■ Using alternate and separate spaces in the ER, ICUs, and other patient care areas to manage known or suspected COVID-19 patients.
■ Separating known or suspected COVID-19 patients from other patients (“cohorting”).
■ Identifying dedicated staff to care for COVID-19 patients.
3. Long term care facilities
○ Limit visitors to the facility
○ Post visual alerts (signs, posters) at entrances and in strategic places providing instruction on hand hygiene, respiratory hygiene, and cough etiquette
○ Ensure supplies are available (tissues, waste receptacles, alcohol-based hand sanitizer)
○ Take steps to prevent known or suspected COVID-19 patients from exposing other patients
○ Limit the movement of COVID-19 patients (e.g., have them remain in their room)
○ Identify dedicated staff to care for COVID-19 patients.
○ Observe newly arriving patients/residents for development of respiratory symptoms.
Shifting Healthcare Delivery Modes during a COVID-19 Outbreak in the United States
Several major impacts can be anticipated during a severe outbreak that could affect the operations of healthcare facilities. These include surges in patients seeking care, the potential for workforce absenteeism from personal or family illness, and effects from social distancing measures such as school closures. Healthcare facilities will likely need to adjust the way they triage, assess and care for patients using methods that do not rely on face-to-face care.
Shifting practices to triaging and assessing ill patients (including those affected by COVID-19 and patients with other conditions) remotely using nurse advice lines, provider “visits” by telephone, text monitoring system, video conference, or other telehealth and telemedicine methods can reduce exposure of ill persons with staff and minimize surge on facilities. Many clinics and medical offices already use these methods to triage and manage patients after hours and as part of usual practices. Recent reports suggest that approximately 80% of COVID-19 patients (of all ages) have experienced mild illness[i]. Managing persons at home who are ill with mild disease can reduce the strain on healthcare systems—however, these patients will need careful triage and monitoring.
Promoting the increased use of telehealth
• Healthcare facilities can increase the use of telephone management and other remote methods of triaging, assessing and caring for all patients to decrease the volume of persons seeking care in facilities.
• If a formal “telehealth” system is not available, healthcare providers can still communicate with patients by telephone (instead of visits), reducing the number of those who seek face-to-face care.
• Health plans, healthcare systems and insurers/payors should message beneficiaries to promote the availability of covered telehealth, telemedicine, or nurse advice line services
Shifts in the way that healthcare is delivered during a COVID-19 outbreak response will be complex. Thorough and consistent communications between all components of the public health and healthcare system will be needed in every community. For example, providers in medical offices, clinics, and other outpatient settings must be informed and know their roles. Pre-hospital care by emergency management services (EMS) and public-safety answering points (PSAPs) will also need to be aware of any altered transport guidance so they can conduct in-home assessments and triage per local guidance.
Reference:
[i] Wu Z, McGoogan JM. Characteristics of and Important Lessons from the Coronavirus Disease 2019 (COVID-19) Outbreak in China. JAMA [Internet] 2020; available from: https://jamanetwork.com/journals/jama/fullarticle/2762130
Strategies to Prevent the Spread of COVID-19 in Long-Term Care Facilities (LTCF)
A new respiratory disease – coronavirus disease 2019 (COVID-19) – is spreading globally and there have been instances of COVID-19 community spread in the United States. The general strategies CDC recommends to prevent the spread of COVID-19 in LTCF are the same strategies these facilities use every day to detect and prevent the spread of other respiratory viruses like influenza.
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.
Prevent the introduction of respiratory germs INTO your facility
• Post signs at the entrance instructing visitors not to visit if they have symptoms of respiratory infection.
• Ensure sick leave policies allow employees to stay home if they have symptoms of respiratory infection.
• Assess residents symptoms of respiratory infection upon admission to the facility and implement appropriate infection prevention practices for incoming symptomatic residents.
Symptoms of respiratory infection, including COVID-19:
• Fever
• Cough
• Shortness of breath
Prevent the spread of respiratory germs WITHIN your facility
• Keep residents and employees informed.
○ Describe what actions the facility is taking to protect them, including answering their questions and explaining what they can do to protect themselves and their fellow residents.
• Monitor residents and employees for fever or respiratory symptoms.
○ 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 unless suspected diagnosis requires Airborne Precautions (e.g., tuberculosis).
○ Healthcare personnel should monitor their local and state public health sources to understand COVID-19 activity in their community to help inform their evaluation of individuals with unknown respiratory illness. If there is transmission of COVID-19 in the community, in addition to implementing the precautions described above for residents with acute respiratory infection, facilities should also consult with public health authorities for additional guidance.
• Support hand and respiratory hygiene, as well as cough etiquette by residents, visitors, and employees.
○ Ensure employees clean their hands according to?CDC guidelines, including before and after contact with residents, after contact with contaminated surfaces or equipment, and after removing personal protective equipment (PPE).
○ Put alcohol-based hand rub in every resident room (ideally both inside and outside of the room).
○ Make sure tissues are available and any sink is well-stocked with soap and paper towels for hand washing.
• Identify dedicated employees to care for COVID-19 patients and provide infection control training.
○ Guidance on implementing recommended infection prevention practices is available in CDC’s free online course – The Nursing Home Infection Preventionist Training – which includes resources checklists for facilities and employees to use.
• Provide the right supplies to ensure easy and correct use of PPE.
○ Post signs on the door or wall outside of the resident room that clearly describe the type of precautions needed and required PPE.
○ Make PPE, including facemasks, eye protection, gowns, and gloves, available immediately outside of the resident room.
○ Position a trash can near the exit inside any resident room to make it easy for employees to discard PPE.
Prevent the spread of respiratory germs BETWEEN facilities
• Notify facilities prior to transferring a resident with an acute respiratory illness, including suspected or confirmed COVID-19, to a higher level of care.
• Report any possible COVID-19 illness in residents and employees to the local health department, including your state HAI/AR coordinator.
For the most up-to-date information, visit www.cdc.gov/covid19.