covid19 infromation


Sheepshead Nursing and Rehabilitation Center Pandemic Emergency Plan 09/20

Background Sheepshead Nursing and Rehabilitation Center shall maintain a Pandemic Emergency Plan (PEP). The plan is designed to aid in the preparedness, response and recovery of pandemics in accordance with state and federal requirements. The circumstances of infectious disease emergencies, including ones that rise to the level of a pandemic, vary due to multiple factors, including type of biological agent, scale of exposure, mode of transmission and intentionality. Infectious disease emergencies can include outbreaks, epidemics and pandemics. A pandemic is an outbreak of an infectious disease that affects people or animals over an extensive geographical area. The impact of a novel virus, to which the general population would have little or no immunity, is not possible to predict as we have learned during the COVID-19 pandemic. We have also learned that the SNF population can be at increased risk of severe illness and mortality due to comorbidities and chronic illness. During a pandemic the facility may need to implement restricted visitation, manage a shortage of staff and/or personal protective equipment and more difficult issues that may threaten the facility’s ability to remain operational.

Preparedness Tasks for all Infectious Disease Events 1. Staff Education on Infectious Diseases  The facility Infection Preventionist (IP) / Designee provides education on Infection Prevention and Management upon hire, annually and as needed for any identified infection prevention and control concerns / updates on an ongoing basis.  The IP/ Designee will conduct annual competency-based education on hand hygiene and donning/doffing Personal Protective Equipment (PPE) for all staff.  The IP / Designee will provide in-service training for all staff on Infection Prevention policies and procedures as needed for event of an infectious outbreak.

2. Develop/Review/Revise and Enforce Existing Infection Prevention Control, and Reporting Policies The facility will continue to review/revise and enforce existing infection prevention control and reporting policies. As needed the facility will communicate with local Epidemiologist to ensure that any new regulations and/or areas of concern as related to Infection Prevention and Control are incorporated into the facility’s infection control prevention plans.

3. Conduct Routine/Ongoing, Infectious Disease Surveillance  At daily morning meeting, the IDT team will identify any issues regarding infection control and prevention.  Facility acquired infections will be tracked/reported by the Infection Preventionist.  Resident infections as well as the usage of antibiotics will be reviewed on a monthly basis to identify any trends. Rates of infectious diseases and detection of significant increases above those rates will be identified and addressed.  Staff shall receive annual education as to the need to report any change in resident condition to supervisory staff for follow up.  Infection surveillance will be ongoing where data will be collected, analyzed, interpreted and disseminated to identify infections and to monitor adherence to recommended IPC practices.

4. Develop/Review/Revise Plan for Staff Testing/Laboratory Services  The facility will conduct staff testing, if indicated, in accordance with NYS regulations and Epidemiology recommendations for a given infectious agent.  The facility shall have prearranged agreements with laboratory services to accommodate any testing of residents and staff including consultants and agency staff. These arrangements shall be reviewed annually and are subject to renewal, replacement or additions as deemed necessary.  DNS/ Designee will check daily for staff and resident testing results and take action in accordance with State and federal guidance.

5. Staff Access to Communicable Disease Reporting Tools  The facility has access to Health Commerce System (HCS), National Operational Research Agenda (NORA) and National Healthcare Safety Network (NHSN).  Designated staff are assigned to report in accordance to state and federal guidelines.  Access to reporting shall be updated as needed.

6. Develop/Review/Revise Internal Policies and Procedures for Stocking Needed Supplies  The Medical Director, Director of Nursing, Infection Control Preventionist and other appropriate personnel will review the policies for stocking needed supplies.  The facility has contracted with Pharmacy Vendor to arrange for 4 weeks supply of resident medications to be delivered should there be a Pandemic Emergency.  The facility has established par levels for Environmental Protection Agency (EPA) approved environmental cleaning agents based on pandemic usage.  The facility has established par levels for PPE.

7. Develop/Review/Revise Administrative Controls With Regards to Visitation and Staff Wellness  All sick calls will be monitored by Department Heads to identify any staff pattern or cluster of symptoms associated with infectious agent. Each Department will keep a line list of sick calls and report any issues to IP/DNS/Designee. All staff members are screened on entrance to the facility to include symptom check and thermal screening as per state and federal guidance.  Visitors will be informed of any visiting restriction related to an Infection Pandemic and visitation restriction will be enforced/lifted as allowed by NYSDOH.  Department Heads / Designee shall identify minimum staffing needs and prioritizes critical and non-essential services, based on residents’ needs and essential facility operations. Planning shall include collaboration with local and regional DOH and CMS to address widespread healthcare staffing shortages during a crisis.

8. Develop/Review/Revise Environmental Controls Related to Contaminated Waste  Areas for contaminated waste are clearly identified as per NYSDOH guidelines.  The facility environmental coordinator shall follow all Department of Environmental Conservation (DEC) and DOH rules for the handling of contaminated waste. The onsite storage of waste shall be labeled and in accordance with all regulations.  Any staff involved in handling of contaminated product shall be trained in procedures prior to performing tasks and shall be given proper PPE.  The facility will amend the policy and procedure on biohazardous wastes as needed related to any new infective agents.

9. Develop/Review/Revise Vendor Supply Plan for Food, Water, and Medication.  The facility maintains a minimum supply of 72 hours of food and water.  The facility has a supply of stock medications for a minimum of 4 weeks.  The facility has access to a minimum of 2 weeks supply of needed cleaning/sanitizing agents in accordance with storage and NFPA/Local guidance.  The facility has an arrangement with a pharmacy to supply medications in the event of an emergency.  Supplies shall be monitored on a quarterly basis to ensure that it is intact and safely stored. Supplies shall be checked weekly as needed during a Pandemic.  Department Head / Designee responsible for monitoring the supply shall report to the Administrator / Designee with any specific needs or shortages.

10. Develop Plans to Ensure Residents are Cohorted based on Their Infectious Status  Residents are isolated/cohorted based on their infection status in accordance with applicable NYSDOH and Centers for Disease Control guidance.  The cohort will be divided into three groups: Unknown, Negative, and Positive as it relates to the infectious agent.  The resident will have a comprehensive care plan developed indicating their cohort group and specific interventions needed.  The facility shall maintain communication with NYS DOH and CDC to ensure that all new guidelines and updates are being adhered to with respect to infection prevention.

11. Develop a Plan for Cohorting Residents Using a Part of a Unit, Dedicated Floor or Wing, or Group of Rooms  The facility will dedicate a wing or group of rooms at the end of a unit in order to cohort residents. This area will be clearly demarcated as isolation area.  Appropriate transmission-based precautions will be adhered to for each of the cohort groups as stipulated by NYS DOH.  Staff will be educated on the specific requirements for each cohort group.  Residents that require transfer to another health care provider will have their cohort status communicated to provider and transporter and clearly documented on the transfer paper work.  The facility shall attempt to have dedicated caregivers assigned to each Cohort group and to minimize the number of different caregivers assigned.

12. Develop/Review/Revise a Plan to Ensure Social Distancing Measures  The facility will review/ revise the policy on communal dining guidelines and recreational activities during a pandemic to ensure that social distancing is adhered to in accordance with State and CDC guidance. Recreation activities will be individualized for each resident.  The facility will post signage indicating directives for social distancing as per NYSDOH and CMS guidance.  Residents and staff will be educated and monitored to maintain social distancing between peers.

13. Develop/Review/Revise a Plan to Recover/Return to Normal Operations  The facility will adhere to directives as specified by, State and CDC guidance at the time of each specific infectious disease or pandemic event e.g., regarding how, when, which activities/procedures/restrictions may be eliminated, restored and the timing of when those changes may be executed.  The facility will maintain communication with the local NYS DOH and CMS and follow guidelines for returning to normal operations. The decision for outside consultants will be made on a case by case basis taking into account medical necessity and infection levels in the community. During the recovery period residents and staff will continue to be monitored daily in order to identify any symptoms that could be related to the infectious agent.

Additional Preparedness Planning Tasks for Pandemic Events 1. Develop/Review/Revise a Pandemic Communication Plan  The facility will ensure that there is an accurate list of each resident’s representative, and preference for type of communication.  Communication of a pandemic includes utilizing established staff contact list to notify all staff members in all departments.  The facility will update its website and the identification of any infectious disease outbreak of potential pandemic.

2. Develop/Review/Revise Plans for Protection of Staff, Residents, and Families Against Infection  Education of staff, residents, and representatives  Screening of residents  Screening of staff  Visitor restriction as indicated and in accordance with NYSDOH and CDC  Proper use of PPE  Cohorting of residents and staff

Response Tasks for All Infectious Disease Events 1. Guidance, Signage, Advisories  The facility will obtain and maintain current guidance, signage advisories from the NYSDOH and the U.S. Centers for Disease Control and Prevention (CDC) on disease-specific response actions.  The Infection Preventionist/Designee will ensure that appropriate signage is visible in designated areas for newly emergent infectious agents.  The Infection Control Preventionist / Designee will be responsible to ensure that there are clearly posted signs for cough etiquette, hand washing, and other hygiene measures in high visibility areas.

2. Reporting Requirements  The facility will assure it meets all reporting requirements for suspected or confirmed communicable diseases as mandated under the New York State Sanitary Code (10 NYCRR 2.10 Part 2), as well as by 10 NYCRR 415.19.  The DNS / Infection Preventionist / Designee will be responsible to report communicable diseases via the NORA reporting system on the HCS.  The DNS / Infection Preventionist / Designee will be responsible to report communicable diseases on NHSN as directed by CMS.

3. Limit Exposure  The facility will implement the following procedures to limit exposure between infected and non-infected persons and consider segregation of ill persons, in accordance with any applicable NYSDOH and CDC guidance, as well as with facility infection control and prevention program policies.  Cohort residents according to their infection status.  Monitor all residents to identify symptoms associated with infectious agent.  Units will be quarantined in accordance with NYSDOH and CDC guidance and every effort will be made to cohort staff.  Follow all guidance from NYSDOH regarding visitation, communal dining, and activities and update policy and procedure and educate all staff.  Out on pass and appointments will be restricted and limited based on NYSDOH and CDC guidance.  Persons entering the building are screened and authorized.  Hand sanitizer will be available upon entrance to facility and on resident units.

4. Separate Staffing  The facility will implement procedures to ensure that as much as is possible, separate staffing is provided to care for each infection status cohort, including surge staffing strategies.

5. Conduct Cleaning/Decontamination  The facility will conduct cleaning/decontamination in response to the infectious disease utilizing cleaning and disinfection product/agent specific to infectious disease/organism in accordance with any applicable NYSDOH, EPA, and CDC guidance.

6. Educate Residents, Relatives, and Friends About the Disease and the Facility’s Response  The facility will educate residents, relatives, and friends with education about the disease and the facility’s response strategy at a level appropriate to their interests and need for information.

7. Policy and Procedures for Minimizing Exposure Risk  The facility will contact all staff including agencies, vendors, other relevant stakeholders on the facility’s policies and procedures related to minimizing exposure risks to residents and staff.  Consultants that service the residents in the facility will be notified and arrangements made for telehealth, remote chart review, or evaluating medically necessary services until the recovery phase according to State and CDC guidelines.

8. Advise Vendors, Staff, and other stakeholders on facility policies to minimize exposure risks to residents  Subject to any superseding New York State Executive Orders and/or NYSDOH guidance that may otherwise temporarily prohibit visitors, the facility will advise visitors and vendors to limit/discontinue visits to reduce exposure risk to residents and staff.  Emergency staff including EMS will be informed of required PPE to enter facility.  Vendors will be directed to drop off needed supplies and deliveries in a designated area to avoid entering the building if possible.  The facility will implement closing the facility to new admissions in accordance with any NYSDOH directives relating to disease transmission.

9. Limiting and Restriction of Visitation  The facility will limit and or restrict visitors as per the guidelines from the NYSDOH.  Residents and representatives will be notified as to visitation restrictions and/or limitations as regulatory changes are made.

Additional Response Tasks for Pandemic Events 1. Ensure Staff Are Using PPE Properly  Appropriate signage shall be posted at all entry points, and on each residents’, door indicating the type of transmission-based precautions that are needed.  Staff members will receive re-education and have competency done on the donning and doffing of PPE.  Infection control rounds will be made by the DNS / IP / Designee to monitor for compliance with proper use of PPE.  The facility has a designated person to ensure adequate and available PPE is accessible on all shifts and staff are educated to report any PPE issues to their immediate supervisor.

2. Post a Copy of the Facility’s PEP  The facility will post a copy of the facility’s PEP in a form acceptable to the commissioner on the facility’s public website and made available immediately upon request.  The PEP plan shall be kept in the nursing office.

3. The Facility Will Update Family Members and Guardians  The facility will communicate with Residents, Representatives as per their preference and document their communication preference in the CCP/medical record.  During a pandemic Representatives of residents that are infected will be notified daily by Nursing staff as to the resident’s status.  Representatives will be notified when a resident experience a change in condition.  Representatives will be notified weekly on the status of the pandemic at the facility including the number of pandemic infections.  The Hotline message will be updated within 24 hours indicating any newly confirmed cases and/or deaths related to the infectious agent.  Residents will be notified with regards to the number of cases and deaths in the facility unless they do not wish to or are unable to be informed. This will be documented in the medical record/CCP.  All residents will be provided with daily access to communicate with their representatives. The type of communication will be as per the resident’s preference i.e. video conferencing / telephone calls, and/or email.

4. Implement Mechanisms for Videoconferencing  The facility will provide residents with no cost, daily access to remote videoconference or equivalent communication methods with Representatives.  The Director of Recreation / Designee will arrange for the time for all videoconferencing.

5. Implement Process/Procedures for Hospitalized Residents  The facility will implement the following process/procedures to assure hospitalized residents will be admitted or readmitted to such residential health care facility or alternate care site after treatment, in accordance with all applicable laws and regulations including but not limited to 10 NYCRR 415.3(i)(3)(iii), 415.19, and 415(i); and 42 CFR 483.15(e).  Prior to Admission/readmission the DNS / Designee will review hospital records to determine resident needs and facility’s ability to provide care including cohorting and treatment needs.

6. Preserving a Resident’s Place  The facility will implement processes to preserve a resident’s place in a residential health care facility if such resident is hospitalized, in accordance with all applicable laws and regulations including but not limited to 18 NYCRR 505.9(d)(6) and 42 CFR 483.15(e).

7. The Facility’s Plan to Maintain at Least a Two-Month Supply of Personal Protective Equipment (PPE)  The facility has implemented procedures to maintain at least a two-month (60 day) supply of PPE sufficient to protect health care personnel and residents.  This facility will maintain contracts with vendors to secure PPE, as needed.  This includes, but is not limited to: o N95 respirators o Face shield o Eye protection o Isolation gowns o Gloves o Masks o Sanitizer and disinfectants (meeting EPA Guidance current at the time of the pandemic)

Recovery of All Infectious Disease Events 1. Activities/Procedures/Restrictions to be Eliminated or Restored  The facility will maintain review of, and implement procedures provided in NYSDOH and CDC recovery guidance that is issued at the time of each specific infectious disease or pandemic event, regarding how, when, which activities/procedures/restrictions may be eliminated, restored and the timing of when those changes may be executed.

2. 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 that re-enter the facility, as per the NYS DOH guidelines during the recovery phase.

end of covid19 infromation


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