Fairview Nursing Care Center Pandemic Response Plan

Continuing to perform essential functions and provide essential services during a pandemic outbreak is vital to Fairview Nursing Care Center’s ability to remain a viable entity during times of increased threats. A pandemic outbreak has been identified in the Hazard Vulnerability Analysis (HVA) as a potential emergency/disaster for Fairview Nursing Care center.

PURPOSE: This plan provides guidance to Fairview Nursing Care Center nursing facilities and may serve as the plan for maintaining essential functions and services during a pandemic. This guidance neither replaces nor supersedes any current, approved FAIRVIEW NURSING CARE CENTER continuity plan, but instead supplements it, bridging the gap between all-hazards continuity planning and the specialized planning that may be necessary to appropriately manage a pandemic outbreak in a unique healthcare setting such as a nursing home.

This guidance stresses that essential functions can be maintained during a pandemic outbreak through appropriate mitigations strategies, including:

  • Social distancing
  • Appropriate Infection Prevention & Control protocols
  • Increased hand hygiene
  • Temporary suspension of non-essential activities
  • Temporary suspension of communal activities, such as dining or activities
  • Temporary suspension of in-person visitation from members of the community
  • Appropriate inventory management and use of Personal Protective Equipment (PPE)

PLANNING ASSUMPTIONS: Fairview Nursing Care Center pandemic plan is based on assumptions included in the Federal Office of Emergency Management (FEMA) National Strategy for Influenza Implementation Assumptions as well as lessons learned from the COVID-19 pandemic. These include:

  • Susceptibility to pandemic viruses will be universal, but also elevated in congregate nursing facilities due to the resident population
  • Efficient and sustained person-to-person transmission serves as a signal of an imminent pandemic
  • Rates of absenteeism will depend on the severity of the pandemic. A pandemic outbreak threatens Fairview Nursing Care Center human resources by potentially removing essential personnel from the workplace for extended periods of time. Public health measures such as quarantining household contacts of infected individuals or mandatory self-quarantine for workers potentially exposed to a virus may increase absenteeism.
  • Multiple waves/periods during which outbreaks occur in a community can be expected, as is historically seen with influenza.
  • Appropriate guidance and/or direction will be provided by federal, state and/or local governments regarding current pandemic status in the areas where FAIRVIEW NURSING CARE CENTER facilities are located.

Fairview Nursing Care Center approach to managing a pandemic, including its plan for managing resident and staff safety and communications with interested parties will be determined by the level of spread of the associated virus, such as COVID-19, in the population:

  • Level 1: No New York State, New York City cases, no impact on staff and patients.
  • Level 2: Cases in New York State and/or New York City, no impact on staff or patients.
  • Level 3: Cases within nursing facilities or in our community members

LEVEL 1 MANAGEMENT

All facilities and programs will designate a pandemic liaison. This person will monitor to ensure that the facility or program is adhering to this policy; will serve as an in-house resource to answer questions from Care Members as well as coordinate educational programs occurring at the facility for Care Members, patients, and families. The liaison should have infection control training.

All facilities and programs will follow and monitor for compliance with Fairview Nursing Care Center Infection Control Policies (See Human Resources, Infection Control Standard of Care, System-Wide).

Facility and program clinical leadership will participate in all pertinent DOH briefings concerning the pandemic.

Resident, Staff and Family Member Safety:

  • Post signs at the entrance instructing visitors not to visit if they have symptoms of the flu. Individuals (regardless of illness presence) who have a known exposure to someone with a confirmed case or who have recently traveled to areas with virus transmission should not enter the nursing home or health center.
    • Visitors who enter the facility will be reminded of the importance of practicing appropriate hand hygiene for their safety.
  • Reinforce sick leave policies and vacation. Ask employees to stay home if they have symptoms of the flu or are ill. They should call rather than coming in for medical advice. Management should monitor sick calls for compliance. If they notice an employee exhibiting signs of infection, they should send that person home.

Addressing Global Spread:

Follow CDC guidelines for screening international travelers. As these guidelines change rapidly, the Chief Medical Officer will provide updates on at least a weekly basis.

If required by the Centers for Disease Control (CDC) or federal, state or local authorities, all employees who have travelled within the time period set out by the authorities to impacted countries/states/locations will be screened for international travel.

If they have traveled to a Level 3 area, they should be sent home, educated about the risk of their exposure. Fairview Nursing Care Center Medical Director/Designee should be contacted to assess whether or not NYCDOHMH should be informed.

Resident Admissions/Readmission:

Assess residents’ symptoms of respiratory infection upon admission to the facility and implement appropriate infection prevention practices for incoming symptomatic residents.

All transfers to the facility will be tracked and observed for 14 days.

MONITORING:

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).

Ensure 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).

Make sure tissues are available and any sink is well-stocked with soap and paper towels for hand washing.

The Director of Enviromental should be notified if there are no hand sanitizers on each floor and in convenient areas.

Human Resources & Staffing:

Facilities and programs will contact temporary worker agencies regarding their contingency plans in case their staff fail to come to work.

Human Resources will:

  • Identify office staff who are able to work from home and have resources to do so.
  • Work with IT to build out lists of personal email addresses & cell phones
  • Identify where Care Members live by zip code

Communication:

The communication plan for Level 1 will be activated.

Level 1 activates that communication plan to include frequent updates to residents and family members.

  • At Level 1, the frequency of updates is defined as one time per week.
  • Updates are sent out via email, text message and traditional mail. Traditional mail is only to be used for broader updates that are not time sensitive.

IT will establish a dedicated hotline for those have questions and concerns.

Fairview Nursing care center will educate the families at our facility so they know the measures we are taking and why.

Provide known information regarding the virus, including information about signs and symptoms, to residents, staff and family members/representatives.

The Director of Social Services/ Admission Director/designee will send an email communication/written letter to family members reminding them not to visit when they are ill or have known exposure to someone with the virus.

Residents will be provided with updates daily via broadcast so they know what measures are being taken for their safety and why.

The Administrator & the Director of Nursing in consultation with the Medical Director, will determine when to activate Level 2 actions.

Facility clinical leadership will participate in all pertinent DOH briefings concerning the pandemic.

Contact the Director of Environmental Services if there is a need to increase the water supply.

Resident, Staff and Family Safety:

The nursing home will monitor all entrances and screen those entering as per Fairview Nursing Care Center Pandemic Screening policy, state, and federal guidance, including staff, visitors and vendors.

When circumstances warrant it, the Administrator/Designee  will decide when it is appropriate to allow some or all those Care Members previously identified during Level 1 to work from home.

No travel – business or personal – should be allowed for all care members that are in managerial position or above. If travel is emergent and necessary, employee will be subject to quarantine under current state and federal guidelines.

Avoid as much as possible all in person meetings across FAIRVIEW NURSING CARE CENTER facilities and non-FAIRVIEW NURSING CARE CENTER persons, like external vendors. Instead use conference calls and other electronic methods.

All facilities and programs will follow and monitor for compliance with Fairview Nursing Care Center Infection Control Policies

Resident Admissions/Readmissions:

Assess residents’ symptoms of infection upon admission to the facility and implement appropriate infection prevention practices for incoming symptomatic residents.

Track all resident admissions and transfers.

Communication:

The communication plan for Level 2 will be activated.

Level 2 communication includes:

  • Bi-weekly update webinars held with the Administrator/Designee and members of the FAIRVIEW NURSING CARE CENTER senior team.
  • Text messages and email alerts continue to be provided with updates.
  • The community at large is encouraged to submit questions to [email protected] NURSING CARE CENTER.org for the duration of the pandemic. This inbox will be used for back and forth communication and enable issues to be resolved as soon as they are raised.

Facility leadership will generate family contact lists to be used in the communications plan. The list will be submitted to the Director, of Nursing and Admission

Families will be kept notified via FAIRVIEW NURSING CARE CENTER public website updates, text messages and other means which will be updated per regulatory requirements for updates.

Refer to Emergency & Disaster Preparedness Plan Policies:

  • Communications – Internal
  • Communications – Residents and Family
  • Communications – Notifying External Authorities

LEVEL 3 MANAGEMENT

The Administrator & Director of Nursing, in consultation with the  Medical Director, will determine when to activate Level 3 actions.

Resident, Staff and Family Safety:

Family members may be restricted from visitation if mandated by NYSDOH or other agency for their protection. When visitation is allowed or the facility is re—opened to visitors under certain circumstances, the FAIRVIEW NURSING CARE CENTER Visitation Policy will be followed.

When circumstances warrant it, the Administrator will decide when it is appropriate to allow some or all those Care Members previously identified during Level 1 to work from home.

Standard Precautions, Contact Precautions, Droplet Precautions, and Eye Protection should be used in caring for an infected person. This means wearing a gown, gloves, facemask, and goggles or a face shield.

Patients who have confirmed diagnoses or are PUIs will be cohorted in a single unit whenever possible or as required by state or federal regulation.

Signages form from the CDC will be used across the Post signs on the door or wall outside of the resident room or confirmed positive wing that clearly describe the type of precautions needed and/or required PPE. To prevent other residents from entering the isolation areas, zippered plastic dividers will be utilized.

The facilty will assure it meets all reporting requirements for suspected or confirmed communicalble diseases as mandated under the NY State  Sanitary Code (10 NYCRR2.10 Part 2) as well as by 10 NYCRR 415.19 (see Annex K of CEMP toolkit for reporting requirements). The DON/Infection preventionist will be responsible to report commincable diseases via the NORA reporting system on the HCS on NHSN as direcrted by the CMS

Provide the right supplies to ensure easy and correct use of PPE, if available. If there is a short supply then gowns, N95 /facemasks, and or face shields or goggles should only be used on those patients that are coughing, unable to keep a face mask on, for example if they have dementia or behavioral health issues, or if they are being suctioned. In all other instances, care members should wear gloves and a surgical/face mask.

Residents with suspected cases should be prioritized for testing, if appropriate testing is available. Staff will maintain regular testing in accordance with CDC and NYSDOH guidelines.

Increase monitoring of ill residents, including assessment of symptoms, vital signs, oxygen saturation via pulse oximetry, and lung auscultation to at least 3 times daily to identify and quickly manage serious infections.

Actively monitor all residents on affected units once per shift. This monitoring must include a symptom check, vitals, lung auscultation, and pulse oximetry.

Patients with confirmed or possible infections should wear a facemask when being evaluated medically, if tolerated.

Avoid floating staff between units whenever possible, or when required by NYSDOH or other regulatory entity.

Use a Line List for data collection and active monitoring of both residents and staff. This tool will provide a line listing of all individuals monitored for or meeting the case definition for the pandemic outbreak.

Once a positive or suspected patient has been discharged or transferred, HCP, including environmental services personnel, should refrain from entering the vacated room until sufficient time (70 minutes for patient care areas, 140 minutes for other settings) has elapsed for enough air changes to remove potentially infectious particles. After this time has elapsed, the room should undergo appropriate cleaning and surface disinfection before it is returned to routine use. Refer to Fairview Nursing Care Center Terminal Cleaning Policy.

Make PPE, including N95 /facemasks, eye protection(faceshield) gowns, and gloves, available immediately outside of the resident room or outside the entrance to the unit/wing.

Have alcohol-based hand rub available in the wing/unit, preferably in each resident’s room.

Position a trash can near the exit inside any resident room to make it easy for employees to discard PPE.

Notify facilities and transporting company prior to transferring a resident with an acute respiratory illness, including suspected or confirmed COVID-19, to a higher level of care.

Supplies including alcohol based disinfectant wipes in accordance with EPA guidance, water,

food, hand sanitizer are to be available. Refer to Fairview Nursing Care Center Emergency management plan on supplies.

Contact the Evironmental Director if there is a need for more supplies.

Mask Management: Each Department  will generate an inventory of PPE and submit it to the Environmental Director at Level 1.

Facemasks will be secured in a room. Face Masks are not to be given out unless approved by the Administrator

Facemasks supply  will be managed by the Environmental Director so as to redistribute them in case one department does not have enough.

Gowns, N95/facemasks, faceshields will be managed centrally to ensure proper use in order to conserve the supply.

Extended and re-use of PPE’s may be implemented in the event of PPE shortages.  Any implementation of extended and reuse of PPE’s will follow state and federal guidance.

Please refer to FAIRVIEW NURSING CARE CENTER COVID-19 PPE Re-Use Strategies for additional information.

PPE Supply

A 60-day supply of PPE will be maintained at FAIRVIEW NURSING CARE CENTER.

The Nursing Home will maintain a plan for identifying what quantities of PPE will be required for 60 days.

FAIRVIEW NURSING CARE CENTER will determine the burn rates/PPE quantities here:

Estimated volume for 60 days (calculated based on COVID-19 pandemic requirements for PPE and actual facility burn rates):

200 patients:  If needing 21 days of care each; 200 PUIs needing 7 days of care each

Anticipate 30% reduction in infected patients due to PROTECT program (with 170 protect team members for 125 isolation rooms)

Gowns: One gown per care member per shift (190*60*1 = 11,400)

Face shields: 1 per Protect team member – disinfect after each patient & reuse (190+30 backups = 220)

Surgical masks: Reuse = 1 per general staff per day (11400*60 = one third of 228,000 = 76,000)

No surgical masks for PROTECT Team members as they will be issued N95 masks

N95 Masks: 2 per PROTECT Team member – will be disinfected at end of each day (2*190=380)

Gloves: no reuse. 21 pairs per bed per day (21*2*200*60 =504,000)

Communication Plan:

The communication plan for Level 3 will be activated.

Level 3 includes all of the communication methods in Level 1 and Level 2, including the use of text alerts, video calls and webinars for both team members and family members.

  • A dedicated hotline for calls website will be updated, maintained and monitored.

Per CMS Guideline: Ref: QSO-20-29-NH:

  • FAIRVIEW NURSING CARE CENTER facilities will notify all residents in the facility, their representatives and families regarding the status of the facility and the residents, not just those who are suspected/confirmed cases.
  • Updates authorized family members anfd guardians of residents infected with the pandemic infectious disease at least once per day and upon a change in resident’s conditon and will be referred to the facility website
  • Updates all residents and authorized family members and guardians once per week on the number of infections and deaths at the facility and will be referred to the facility website
  • Notification will include all regulatorily-required information, such as through notification requirements when confirmed or suspected cases have been identified.
  • All reporting timeframes will be adhered to.
  • Fairview Nursing Home will make all reasonable efforts to properly inform their residents, representatives and families of the information required, including through means such as FAIRVIEW NURSING CARE CENTER facility website posting/updates.

Per NYSDOH guideline C20-01:

If visitation is restricted, the facilities will implement various, cost-free means to keep residents and their families connected during the pandemic. This includes:

  • Face-to-face video calls
  • Phone calls
  • Outdoor visitation when allowed.
  • Visiting Booth
    • Please refer to FAIRVIEW NURSING CARE CENTER Resumption of Visitation Policy.

Pandemic Response Plan Staff Education and Training

As part of each staff member’s new hire orientation and annual re-orientation, training/competencies is provided in full regarding the FAIRVIEW NURSING CARE CENTER Emergency Preparedness Plan (EPP). The FAIRVIEW NURSING CARE CENTER Pandemic Response plan will be reviewed as part of these education sessions.

A full tabletop drill will be conducted with nursing home staff members as part of staff training.

Recovery of all infectious Disease Events

  • Activities/Procedure/Restrictions to be Eliinated or Restored
    • The facility will focus on recovery of services based on the return to operations directives from CDC, NYSDOH and the needs of the residents and satff to reinstate said services to pre-pandemic operations.
  • Recovery/Return to Normal Operations
    • The facility will communicate any relevant activities regarding recovery/ return to normal operations, with staff, families/guardians and other relevant stakeholders.
    • The facility will ensure that during the recovery phase all residents and staff will be monitored and tested to identify any developing symptoms related to the infectious agent in accordance with State and CDC guidance.
    • The facility will screen and test outside consultants thar re-enter the facility, as per the NYS DOH guidelines during the recovery phase.
    • During recovery period, residents and staff will continue to be monitored daily to identify any symptoms that could be related to the infectious agent.