covid-19 and ltc...2021/01/07 · covid-19 and ltc january 7, 2021 guidance and responses were...

COVID-19 and LTCJanuary 7, 2021

Guidance and responses were provided based on information known on 1/7/2021 and may become out of date. Guidance is being updated rapidly, so users should look

to CDC and NE DHHS guidance for updates.

Questions and Answer SessionUse the QA box in the webinar platform to type a question. Questions will be read aloud by the moderator.If your question is not answered during the webinar, please either e-mail it to NE ICAP or call during our office hours to speak with one of our IPs.

Slides and a recording of this presentation will be available on the ICAP website:

Panelists today are:

Moderated by Marissa Chaney

https://icap.nebraskamed.com/coronavirus/https://icap.nebraskamed.com/covid-19-webinars/

Dr. Salman Ashraf [email protected]

Kate Tyner, RN, BSN, CIC [email protected]

Margaret Drake, MT(ASCP),CIC [email protected]

Sarah Stream, MPH, CDA [email protected]

Karen Amsberry, MSN, RN [email protected]

Lacey Pavlovsky, RN, MSN, CIC [email protected]

Rebecca A. Fein, DHSc, MBA, MS [email protected]

https://icap.nebraskamed.com/coronavirus/https://icap.nebraskamed.com/covid-19-webinars/mailto:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]

Covid-19 and LTC Disclosures1.0 Nursing Contact Hour and 1 NAB Contact Hour is awarded for the LIVE viewing of this webinar

In order to obtain nursing contact hours, you must be present for the entire live webinar, complete the attendance poll and post webinar survey

No conflicts of interest were identified for any member of the planning committee, presenters or panelists of the program content

This CE is hosted Nebraska Medicine along with Nebraska ICAP and Nebraska DHHS

Nebraska Medicine is approved as a provider of nursing continuing professional development by the Midwest Multistate Division, an accredited approver by the American Nurses Credentialing Center’s (ANCC) Commission on Accreditation

https://www.nytimes.com/interactive/2020/us/nebraska-coronavirus-cases.html

https://www.nytimes.com/interactive/2020/us/nebraska-coronavirus-cases.html

Helping People Live Better Lives.

5

COVID Test Result Reporting

Rebecca A. Fein, DHSc, MBA, MS

Data Quality Specialist – Public Health

December 2020


6

1. Reporting via excel spreadsheet.

2. Reporting via guardian – self-uploading on the guardian website.

3. National Health Safety Network (NHSN).

How do I report Covid Test Results to the State?


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CLIA # - Everyone doing testing needs to have one and needs to put it on their spreadsheet.

Medical Director – First name, last name, NPI – Many ALFs do not have a medical director or medical director NPI, just leave it blank.

Patient information – First name, last name, date of birth – All required to match in the system and please double check the dates.

Device name – name of the device you are using to test.

Test Performed – SARS-CoV-2 Rapid Antigen

Lab Result – Result of the test

Sample Collection date – date sample collected and testing performed.

Sample source – from where? Most of the time this will be nasal mid-turbinate.

Result sent date – date testing results sent to DHHS.

Gender, Race, and ethnicity

The spreadsheet

Rapid Testing:

Sample should

be collected, test

performed, and

result sent the

same date.


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Patient address – for residents use the facility address, for staff use their residential address.

Patient City – residential city

Patient State – residential state

Patient Phone number – for residents use the facility phone number if no residential phone number. For staff use their residential or mobile number.

Patient zip code – residential zip code

Facility phone number - Phone number of your facility

Name of facility that performed the test

Facility city

Facility state

Comments – put any notes here that you feel are necessary.

The spreadsheet

Name the file

facilityname.date

Example:

NebraskaALF1.1.2021


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• Email [email protected]

• We will respond with the excel template, companion documents, and other guidance.

• Submit your testing results within 24 hours of testing to [email protected]

• If positive results, please report the same day.• Call your LHD so they can assist you ASAP

Where do I begin?


10

Things We Never Knew We Needed to Know

POC

Test

Bina

xNO

W

Mid-Turbinate =

Nasaloscopy!!

DHHS.Epi…Ethnicit

y

Race

report2020

NPI

Do we have a

CLIA#?

BD Veritor

Plus

Swab, Swab,

Swab

Using

Guardian


11

Number reporting to DHHS – 267

Building good relationships and collaboration

Big learning curve for all of us

Large # of Errors Rare Errors

Did I do it Right? We’ve got this!

Average # of Sheets Received Every Day = 150

How is it Going?


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• Reach out if you have questions/need help.

• Don’t be embarrassed if you see yourself in the ‘Common Errors’ slides.

• Double-check your sheets to make sure they don’t contain the common errors, or previously submitted results.

• Please respond to us if we ask for corrections/updates.

Main Takeaways


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• Incorrect entries

• Blank fields

• Multiple Tabs/Sheets

• Late reporting

• Reporting results already reported previously

Where We Need Your Help


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Common Errors: Dates

Must be

Month/Date/Year

MM/DD/YYYY

Double check

dates for

accuracy!


15

Common Errors: Dates

Do NOT

Enter a

Time

Don’t

leave

Blanks


16

Common Errors: Excel Functions

Don’t use Excel functions. In

the example here, using the

“now” function creates an

inaccurate results sent date.

This is because “now” sets

the date to now.


17

Common Errors: Missing Contact Info


18

Common Errors: Missing Result


19

Common Errors: Invalid Results

• Result: Refused

• Result: NA

• Result: On Leave

• Result: Vacation

• Result: Lost Sample

• Result: Off

• Result: Out of town

P, N, I, C, Y, D, ND, Positive,

Negative, Yes, Inconclusive,

Detected, Not Detected


20

Common Errors: Multiple tabs

Submit Just One Sheet Each Time

Our System can NOT process multiple sheets.


21

Common Errors: Race and Ethnicity

Acceptable Race fields: Asian (or A), Black (or B), American Indian

or Alaskan Native, White (or W), Other (or O), Unknown (or U)

Acceptable Ethnicity fields: Hispanic or Latino (or H). Not Hispanic

or Latino (or NH), Unknown (or U)

• Please use ‘Unknown’ sparingly – information is usually in

patient’s medical record

• If patient is Hispanic, please enter Race as Other (or White) and

Ethnicity as Hispanic or Latino


22

Common Errors: Gender

• Making up codes: MM, MF, FF, FM,

Neutral

• Blank

• This data is important to policy

decisions, including funding

M, F, U, Male,

Female, Unknown


23

Common Errors: Other

• Hidden Rows

• Filtering

• Blank fields

• Incomplete rows

• Previously submitted results


24

Transition to NHSN Reporting


25

Disclaimer


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• Enroll if you have not done so already; no need to re enroll if already using the other Reporting Modules

• Get the increased LTCF SAMS level access to NHSN

• Contact: [email protected] for assistance

• Link: https://www.cdc.gov/nhsn/ltc/covid19/sams-access.html

• Manual entry of data into NHSN – other options to upload a file is under development

NHSN Process

mailto:[email protected]


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• ONE place for your facility to report multiple required pieces of information

• Once data has been entered into NHSN; it will auto populate on subsequent entries

• Will only need to fill in the test date and result once the person exists in the system

• Address for persons auto populates the facility address. Must enter it for staff and visitors the first time.

• Test ordered and specimen source defaults in based on type of device used

• LTC that are not Medicare certified; Assisted Living and others can use NHSN if want to - It is free

Positive Aspects of NHSN Reporting for POC Tests


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• Delays in getting SAMS change in security

• Intermittently, if the Test Date field is completed by typing in a date, rather than using the calendar fill option, the system may present previously entered dates from which a selection may be made. If one of these is selected, there may be an inability to enter POC test results.

• To avoid this issue, please use the calendar option to enter Test Date. No date yet identified for resolution.

• Usually the NHSN system creates what is called an ‘Accession Number’ for each test. Each number is specific to the person being tested.

• Do NOT over write what the system assigned or enter the same number for every person.

• We had one facility do this and it assigned over 100 results to one person and did not report the other 99 results for others that were tested

NHSN Known Issues


29

The Point of Care Test Reporting Tool replaces the Excel sheets you send us today.

Using the other Reporting Pathways does NOT replace the Excel sheets you send us.

5 Modules: Reporting Pathways are Not POC Test Results

Number transitioning to reporting via NHSN: 24


30

Do NOT stop sending us your Excel sheets with test results until you have successfully submitted test results using the Point of Care Test Reporting Tool.

• NOTIFY DHHS.EPI EMAIL IF YOU NEED ASSISTANCE.

When you have successfully submitted POC Test Results using the POC Test Reporting Tool

• Notify DHHS via the [email protected] email

• Include the date you submitted your first POC test results via NHSN

• DHHS does NOT receive any notification from NHSN that you are sending results to them

• Then stop sending the spreadsheets to DHHS

When to Stop Sending Test Results to DHHS

Must be no lapse in POC test

results reporting: to EITHER

DHHS OR NHSN

mailto:[email protected]

Reporting COVID-Related Deaths to

NHSN

Total DeathsDefined by NHSN as residents who have died from any cause in the facility or another location.

This count includes new COVID-19 related deaths AND NON-COVID-19 related deaths.

Notes:

• Include each resident death only once in Total Deaths count, on the date of death.

• Total Deaths should NEVER be lower than the COVID-19 Deaths in a reporting week.

• Residents discharged from the facility are excluded from the count.

https://www.cdc.gov/nhsn/pdfs/covid19/ltcf/57.144-toi-508.pdf

COVID-19 DeathsDefined by NHSN as residents who died from SARS-CoV2 (COVID-19) related complications and includes resident deaths in the facility AND in other locations, such as an acute care facility, in which the resident with COVID-19 was transferred to receive treatment.

Conditional. Based on the number of submitted Total Deaths, report how many of the deaths were residents with either a positive COVID-19 viral test result, had signs and/or symptoms of COVID-19, or were on transmission-based precautions for COVID-19, as defined by the CDC.

Notes:

If the facility receives an autopsy result indicating a positive SARS-CoV2 (COVID-19) viral test result for a resident who was not initially included in the COVID-19 Deaths count, previously submitted NHSN data must be edited to include the death in the COVID-19 Deaths count.

• The edited date must reflect the date of death.

• The COVID-19 Deaths count cannot be higher than the Total Deaths count in a reporting period.

• Residents discharged from the facility are excluded from the count.


ExampleA SNF documented the following Total Deaths this week:

• Monday: 2 Total Deaths submitted. Of the two deaths, 1 resident was on transmission-based precautions for COVID-19 and the second resident recovered from COVID-19 last month.

• Tuesday: 0 Total Deaths submitted.

• Wednesday: 0 Total Deaths submitted.

• Thursday: 1 Total Deaths submitted. The resident did not have a history or positive COVID-19 test result.

• Friday: 0 Total Deaths submitted. A nurse did recognize a previously discharged resident in the obituary of a local newspaper.

• Saturday: 2 Total Deaths submitted. Of these two deaths, one resident had active COVID-19 infection and the other resident did not have COVID-19. However, 2 weeks later an autopsy report indicated a positive SARS-CoV-2 (COVID-19) viral test result on the second resident not known to have COVID-19.

• Sunday: 1 Total Deaths submitted for a resident who died 1 week after being transferred to an acute care facility for treatment of COVID-19 infection.

The following Total Deaths counts

submitted to NHSN: 6

• Monday: 2

• Tuesday: 0

• Wednesday: 0

• Thursday: 1

• Friday: 0

• Saturday: 2

• Sunday: 1

The following COVID-

19 Deaths counts submitted to

NHSN: 4

• Monday: 1• Tuesday: 0• Wednesday: 0• Thursday: 0• Friday: 0• Saturday: 2 (previously submitted

count was updated after receiving autopsy report)

• Sunday: 1


COVID-19 Vaccination Resources

Preparing Staff for COVID-19 Vaccination

CDC has developed a LTC Toolkit for COVID-19

Vaccination and is available for use

at https://www.cdc.gov/vaccines/covid-

19/toolkits/long-term-care/prepare-staff.html

Facilities can use or adapt these ready-made materials to

build confidence about COVID-19 vaccination among

facility staff:

• Sample Letter to Staff About COVID-19

Vaccinationpdf icon

• Fact Sheet – Answering Common Long-Term Care

Staff Questions about COVID-19 Vaccinespdf icon

• Poster – Long-Term Care Facility Staff: Reasons to

Get Vaccinated Against COVID-19 Todaypdf icon

• Fact Sheet – Learn About the New mRNA COVID-19

Vaccinespdf icon

• Poster – Getting ”Back to Normal” Is Going to Take

All Our Toolspdf icon

• General resources including posters, fact sheets, and

stickers for staff

• Slides that provide information on what staff should

know about the vaccine and tips to build confidence

among staff and residents

• Additional FAQs for healthcare personnelpdf icon and

on COVID-19 vaccination in the workplace

https://www.cdc.gov/vaccines/covid-19/toolkits/long-term-care/prepare-staff.htmlhttps://www.cdc.gov/vaccines/covid-19/toolkits/long-term-care/downloads/Sample-Letter-to-Staff.pdfhttps://www.cdc.gov/vaccines/covid-19/toolkits/long-term-care/downloads/answering-staff-questions.pdfhttps://www.cdc.gov/vaccines/covid-19/downloads/COVID-19-LTCF-staff-poster-reasons-to-vaccinate-today.pdfhttps://www.cdc.gov/coronavirus/2019-ncov/downloads/vaccines/facts-covid-vaccines-english-508.pdfhttps://www.cdc.gov/vaccines/covid-19/downloads/all-of-our-tools.pdfhttps://www.cdc.gov/vaccines/covid-19/health-systems-communication-toolkit.html#postershttps://www.cdc.gov/vaccines/covid-19/health-systems-communication-toolkit.html#faqshttps://www.cdc.gov/vaccines/covid-19/health-systems-communication-toolkit.html#stickershttps://www.cdc.gov/vaccines/covid-19/health-systems-communication-toolkit.html#slideshttps://www.cdc.gov/vaccines/covid-19/downloads/hcp-employees-general-faqs.pdf

Hot Topics and FAQ's

Hot Topics

Question:

What do we do if a staff member tests positive in a facility where all residents have been positive?

Answer:

Contact tracing should occur and exposed residents should be monitored but testing asymptomatic residents will not be needed until 90 days after resident positivity. Recovered asymptomatic residents within 90 days of infection should still have symptom assessment, but no need to do quarantine of recovered + exposed + asymptomatic residents.

Post 90 days, standard quarantine process resumes (i.e., yellow zone).

Question:

Now that vaccine clinics are happening, what does the future look like?

Answer:

As of now, nothing with testing, visitation, or other infection control measures have changed as far as CMS guidance. As soon as things change, we will address them

Hot TopicsQuestion:

Can we go back to communal dining and activities? Like can we start phasing again?

Answer:

As of right now, you will need to continue to follow the existing CMS and state phasing guidance on communal dining and activities.

Question:

How to proceed out of a facility-wide red zone?

Answer:

Begin transferring out of a red zone by deep cleaning each room sequentially and bringing it out of isolation once cleaned. This cleaning includes all horizontal touch surfaces and laundering linens and room divider curtains. Change signage as rooms are cleaned and "released." Red Zone PPE will need to be used in each room until they are cleaned and transitioned to Green Zone.

Hot TopicsQuestion:

Visitors who have had the COVID vaccination are not wanting to follow protocols because they are thinking they are "covered". How do we address this with our visitors?

Answer:

The facility is accountable to ensure that visitors comply with CMS guidance on visitation. https://www.cms.gov/files/document/qso-20-39-nh.pdf

• Revisit the facility policies that follow CMS guidance with the visitors and make sure they understand that all the policies are for the safety of everyone involved.

• Reiterate that nothing can change until CMS provides updated guidance as the vaccine continues to be administered.

https://www.cms.gov/files/document/qso-20-39-nh.pdf

Hot TopicsQuestion:Should a facility wait to administer a TB skin test if a patient has received a COVID vaccine in the last 14 days?

Answer:

It is recommended to do the TST before COVID-19 vaccine is given because there is no data on the effect of the vaccine on

TST results.

Interpretation of tuberculosis test results in vaccinated persons

Inactive vaccines do not interfere with tuberculosis (TB) test results. There is no immunologic reason to believe either a Tuberculin Skin Test

(TST) (administered by intradermal placement of 0.1 cc of purified protein derivative) or blood draw for interferon gamma release assay

(IGRA) would affect the safety or effectiveness of mRNA COVID-19 vaccines. We have no data to inform the impact of the COVID-19 mRNA

vaccines on either TB test for infection (i.e., TST or IGRA).

For healthcare personnel or patients who require baseline TB testing (at onboarding or entry into facilities) at the same time they are to

receive an mRNA COVID-19 vaccine:

• Perform TB symptom screening on all healthcare personnel or patients.

• If utilizing the IGRA, draw blood for interferon gamma release assay prior to COVID-19 vaccination.

• If utilizing the TST, place prior to COVID-19 vaccination.

• If vaccination has been given and testing needs to be performed, defer TST or IGRA until 4 weeks after COVID-19 vaccine 2-dose

completion.

– All potential recipients of COVID-19 vaccination should weigh the risks and benefits of delaying TST/IGRA with their

providers.

– For healthcare personnel who require testing for other reasons:

– Perform TB symptom screening on all healthcare personnel

– Test for infection should be done before or at the same time as the administration of COVID-19 vaccination. If this is not

possible, prioritization of test for TB infection needs to be weighed with the importance of receiving COVID-19 vaccination

based on potential COVID-19 exposures and TB risk factors.

• Healthcare personnel with high-risk conditions for TB progression should be fully evaluated as soon as possible.

• Healthcare personnel without high-risk conditions for TB progression should proceed with contact tracing (i.e.,

symptom screening, chest radiograph or other imaging, specimen for microbiologic evaluation) but delay test for TB

infection (TST or IGRA) if prioritized for receiving COVID-19 vaccination.

• All potential recipients of COVID-19 vaccination should weigh the risks and benefits of delaying TST/IGRA with their

providers.

https://www.cdc.gov/vaccines/covid-19/info-by-product/clinical-considerations.html

https://www.cdc.gov/vaccines/covid-19/info-by-product/clinical-considerations.html

UV DisinfectionUpdate on location

Omaha Area UV Mask Disinfection Site!

Deanna Novak Administrator

Good Samaritan Society-Millard

(O) 402-895-2266

Remember:

KN95 respirators should only be worn 1 shift, and not reused/disinfected.

• What type of respirators can be UV disinfected

https://www.cdc.gov/niosh/npptl/respirators/testing/DeconResults.html

http:// https:/www.cdc.gov/niosh/npptl/respirators/testing/DeconResults.html

Updates and Announcements

Upcoming Webinar

• The COVID-19 Vaccine: Facts vs Fiction

• Hosted by the University of Nebraska SIM-NE

• Presented by Dr. Mark Rupp and Dr. Eric Ernest

• January 7, 2021 at 6:30 pm CST

• Targeted to rural providers, including EMS

• Registration for the event is not required to view the event. However, if you wish to receive an EMS continuing education certificate or non-peer reviewed nursing continuing professional development certificate you must register for the live event ahead of time online at http://bit.ly/COVIDvaccine1

• This Facebook Live event can be found at https://fb.me/e/3Afr4yn2E or by searching for @simulation.in.motion.ne

https://l.facebook.com/l.php?u=https%3A%2F%2Fbit.ly%2FCOVIDvaccine1%3Ffbclid%3DIwAR1uP1Vubhw6yGxbNwi5Lbn08FFw5CYJDI5o4J0Opf_VMJjF4_ZMlEnNEP8&h=AT0-oAoaFu3ShZGHZuAcN3kAVEX3SGYmN9-kEBWZ99aEYm_O-gU37BnWUMFL6umypRtBV6Lwji2lwo2Qy9hx5AlWrLrNFkEOhJuLfAVQjZduNshhpnypf_uLzxUm_a5ces2y&__tn__=q&c%5b0%5d=AT2Qd7fPokK3pqvP_vgrYRUFZzDV8vRQf6_pqvlmT3bydD-vhaVR4IQls_0V6Ekc-eOW5mRiqZe0p739kJndq7HdFHR3mChIJd54cS_AZrbhpXemvzb32LYRo98mWpIPi4gJJQv--6VCQQCjPhp9tVqHfuCLcXb6l11J4hbhsKW-QpANsQhttps://fb.me/e/3Afr4yn2E

COVID-19 Tele-ICAR Assessments

• ICAP is offering COVID-19 focused virtual ICAR assessments to outpatient and acute care facilities

• The assessment will assess the status of COVID-19 policies and procedures and offer a summary of recommendations from ICAP

• Home Health Agencies fall under the outpatient umbrella and ICAP has developed a HH focused survey to support our HH partners

• Contact Ne ICAP at 402.552.2881 to be connected with the IP responsible for the facility

Webinar CE Process1 Nursing Contact Hour and 1 NAB Contact Hour is offered for attending

this LIVE webinar

1. A survey will open upon completion of the webinar, you must complete the survey to get your CE credits. Please note: Your web browser makes a difference. Google Chrome is the suggested browser.

2. Nursing Credit hours will include the entire month of verified CE on one certificate (Ex: You attended 2 webinars during the month of November, your certificate will reflect the 2 webinar dates and 2 credit hours earned)

3. Nursing Certificates will be emailed to you by the 15th of the following month

4. You must have a NAB account to claim credit with them

5. You must provide your NAB number for us to submit attendance to the NAB system

Direct any CE questions to Sarah Stream, MPH, CDA at [email protected]

Infection Prevention and Control:Office and On-Call Hours

Call 402-552-2881

Office Hours are Monday – Friday 8:00 AM - 10:00 AM Central Time2:00 PM - 4:00 PM Central Time

On-Call Hours are Monday – Friday 4:00 PM – 8:00 PM and

8:00 AM – 8:00 PM Weekends and Holidays

Questions and Answer Session

Use the QA box in the webinar platform to type a question. Questions will be read aloud by the moderator.

Panelists:• Dr. Salman Ashraf, MBBS• Kate Tyner, RN, BSN, CIC• Margaret Drake MT (ASCP), CIC• Sarah Stream, MPH, CDA• Karen Amsberry, MSN, RN• Lacey Pavlovsky, RN, MSN, CIC

• Rebecca A. Fein, DHSc, MBA, MS

• Moderated by Marissa Chaney

• Supported by Margaret Deacy

• Slide support from Lacey Pavlovsky,

RN, MSN, CIC

https://icap.nebraskamed.com/resources/

Don’t forget to Like us on Facebook for important updates!
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covid-19 and ltc...2021/01/07 · covid-19 and ltc january 7, 2021 guidance and responses were...

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