COVID-19: Long-Term Care Facilities

The following measures should be implemented in ALL long-term care facilities throughout Georgia, regardless of whether there are increased respiratory illness or confirmed cases of COVID-19 in the facility, and regardless of the number of persons diagnosed with COVID-19 in the immediate area. These precautions are critical for the protection of residents of these facilities. 

  • Restrict all visitors and non-essential health care personnel, except for certain compassionate care situations, including end of life. 
  • Cancel communal dining and all group activities, both internal and external. 
  • Establish appropriate social distancing infrastructure for residents and staff, and promote frequent hand hygiene 
  • Implement active screening of residents for symptoms (fever, cough, shortness of breath, chills, repeated shaking with chills, headache, sore throat, new loss of taste or smell, or muscle pain.)
  • Screen all staff at the beginning of their shift for fever and symptoms 
  • Establish a mechanism so that staff who work in multiple locations are required to report their exposure to a COVID-19 case in other facilities and then follow guidelines for 14-day quarantine before returning to work. 
  • Reinforce adherence to infection prevention and control measures, including hand hygiene and selection of personal protective equipment (PPE) 
  • Consider implementing universal use of facemasks for HCP while in the facility. Although this is ideal, the availability of masks must be considered. 
  • Use Standard, Contact, and Droplet Precautions with eye protection when caring for residents with an undiagnosed respiratory infection, unless the suspected diagnosis requires Airborne Precautions (e.g., tuberculosis). 
  • Make sure that EPA-registered, hospital-grade disinfectants are available to allow for frequent cleaning of high-touch surfaces and shared resident-care equipment (https://www.epa.gov/pesticide-registration/list-n-disinfectants-use-against-sars-cov-2)
  • Create a plan to cohort residents with symptoms of respiratory infection, including dedicating healthcare personnel to work only on affected units. 

Facilities without persons diagnosed need to be prepared for an outbreak of COVID-19 in their facility. Critical planning elements include: 

  • Rapid identification and management of ill residents 
  • Considerations for visitors and consultant staff 
  • Supplies and resources 
  • Sick leave policies and other occupational health considerations 
  • Education and training 
  • Surge capacity for staffing, equipment and supplies, and postmortem care 

The following checklist can help guide planning: https://www.cdc.gov/coronavirus/2019-ncov/downloads/novel-coronavirus-2019-NursingHomes-Preparedness-Checklist_3_13.pdf

If a confirmed case of COVID-19 is diagnosed in a facility, aggressive action should immediately be taken and the health department should be contacted for further guidance: 

  • Place residents in isolation if possible.  
    • If they leave their room, residents 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). 
       
  • Implement universal use of facemask for HCP while in the facility. 
    • HCP should wear all recommended PPE (gown, gloves, eye protection, N95 respirator or, if not available, a facemask) for the care of all residents, regardless of presence of symptoms. Implement protocols for extended use of eye protection and facemasks. o If PPE supplies are limited, strategies for extended PPE use and limited reuse should be employed (https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/index.html)

Notify the health department immediately of the following in residents or in staff: 

  • any case of unexplained severe respiratory illness   
  • clusters of 2 people or more with respiratory symptoms  
  • a positive COVID-19 test  

It is critical to identify any potential COVID-19 infections in long-term care facilities early, before it has a chance to spread.  In these urgent situations, DPH and District Health Department staff can support facilities in evaluating risk among residents and staff, facilitating COVID-19 testing, and making recommendations to prevent spread (call Health Department or 866-PUB-HLTH).  

 

Resources: 

CDC Recommendations: https://www.cdc.gov/coronavirus/2019-ncov/healthcare-facilities/preventspread-in-long-term-care-facilities.html.

Planning checklist: https://www.cdc.gov/coronavirus/2019-ncov/downloads/novel-coronavirus-2019Nursing-Homes-Preparedness-Checklist_3_13.pdf

  The CDC website also has information for facility preparation to prevent the spread of COVID-19 in long-term care facilities.