Jeannine LeCompte, Compliance Research Specialist
The Centers for Disease Control and Prevention (CDC) has issued new recommendations for long-term care facilities (LTCs) in the wake of the ongoing COVID-19 crisis, which are aimed at managing residents who display symptoms of the disease.
The facility should actively monitor all residents upon admission and at least daily for fever (T≥100.0° F) and symptoms of COVID-19 (shortness of breath, new or change in cough, sore throat, muscle aches). If any resident tests positive for fever or symptoms, the following Transmission-Based Precautions must be implemented:
- Older adults with COVID-19 may not show typical symptoms such as fever or respiratory symptoms. Atypical symptoms may include new or worsening malaise, new dizziness, or diarrhea. Identification of these symptoms should prompt isolation and further evaluation for COVID-19.
- The local relevant health department should be notified about residents or healthcare personnel (HCP) with suspected or confirmed COVID-19, residents with severe respiratory infection resulting in hospitalization or death, or more than three residents or HCP with new-onset respiratory symptoms within 72 hours of each other.
- If COVID-19 is suspected, based on evaluation of the resident or prevalence of COVID-19 in the community, the facility should use an N95 or higher-level respirator (or facemask if a respirator is not available), eye protection (i.e., goggles or a disposable face shield that covers the front and sides of the face), gloves, and gown, as basic personal protective equipment (PPE).
The CDC advised that cloth face coverings are not considered PPE and should not be worn by HCP.
Residents with known or suspected COVID-19 do not need to be placed into an airborne infection isolation room (AIIR) but should ideally be placed in a private room with their own bathroom. Residents with COVID-19 should, ideally, be cared for in a dedicated unit or section of the facility with dedicated HCP.
As roommates of residents with COVID-19 might already be exposed, it is generally not recommended to place them with another roommate until 14 days after their exposure, assuming they have not developed symptoms or had a positive test.
Increase monitoring of ill residents, including assessment of symptoms, vital signs, oxygen saturation via pulse oximetry, and respiratory exam, to at least three times daily to identify and quickly manage serious infection. The monitoring of asymptomatic residents should be increased from daily to every shift to more rapidly detect any with new symptoms.
Finally, if it becomes necessary to remove a resident to a high care institution, the transport personnel and the receiving facility should be notified about the suspected diagnosis prior to transfer. While awaiting transfer, residents should wear a cloth face covering or facemask (if tolerated) and be separated from others (e.g., kept in their room with the door closed).
