On April 27, 2021, the Centers for Disease Control and Prevention (CDC) updated their recommendations for healthcare personnel (HCP) while at work, and for all patients and residents while they are being cared for in a healthcare setting. Key recommendations for nursing homes include:
Indoor visitation could be permitted for all residents, except as noted:
- Indoor visitation for unvaccinated residents should be limited solely to compassionate care situations if the COVID-19 county positivity rate is >10% and <70% of residents in the facility are fully vaccinated
- Indoor visitation should be limited solely to compassionate care situations for:
- Vaccinated and unvaccinated residents with SARS-CoV-2 infection until they have met criteria to discontinue Transmission-Based Precautions.
- Vaccinated and unvaccinated residents in quarantine until they have met criteria for release from quarantine.
- Facilities in outbreak status should follow guidance from state and local health authorities and the Centers for Medicare & Medicaid Services (CMS) on when visitation should be paused.
- Visitors should be counseled about their potential to be exposed to SARS-CoV-2 in the facility if they are permitted to visit.
Physical distancing and source control recommendations when both the patient/resident and all of their visitors are fully vaccinated:
- While alone in the patient/resident’s room or the designated visitation room, patients/residents and their visitor(s) can choose to have close contact (including touch) and to not wear source control.
- Visitors should wear source control and physically distance from other healthcare personnel and other patients/residents/visitors that are not part of their group at all other times while in the facility.
Physical distancing and source control recommendations when either the patient/resident or any of their visitors are not fully vaccinated:
- The safest approach is for everyone to maintain physical distancing and to wear source control. However, if the patient/resident is fully vaccinated, he/she can choose to have close contact (including touch) with their unvaccinated visitor(s) while both continue to wear well-fitting source control.
Who should not participate in communal activities?
- Vaccinated and unvaccinated patients/residents with SARS-CoV-2 infection, or in isolation because of suspected COVID-19, until they have met criteria to discontinue Transmission-Based Precautions.
- Vaccinated and unvaccinated patients/residents in quarantine until they have met criteria for release from quarantine.
What infection prevention and control practices are recommended when planning for and allowing communal activities?
Patients/Residents
- Group activities:
- If all patients/residents participating in the activity are fully vaccinated, then they may choose to have close contact and to not wear source control during the activity.
- If unvaccinated patients/residents are present, then all participants in the group activity should wear source control and unvaccinated patients/residents should physically distance from others.
- Communal dining:
- Fully vaccinated patients/residents can participate in communal dining without use of source control or physical distancing.
- If unvaccinated patients/residents are dining in a communal area (e.g., dining room) all patients/residents should use source control when not eating and unvaccinated patients/residents should continue to remain at least 6 feet from others.
- Patients/residents taking social excursions outside the facility should be educated about potential risks of public settings, particularly if they have not been fully vaccinated, and reminded to avoid crowds and poorly ventilated spaces. They should be encouraged and assisted with adherence to all recommended infection prevention and control measures, including source control, physical distancing, and hand hygiene. If they are visiting friends or family in their homes, they should follow the source control and physical distancing recommendations for visiting with others in private settings as described in the Interim Public Health Recommendations for Fully Vaccinated People.
Healthcare Personnel
- In general, fully vaccinated HCP should continue to wear source control while at work. However, fully vaccinated HCP could dine and socialize together in break rooms and conduct in-person meetings without source control or physical distancing. If unvaccinated HCP are present, everyone should wear source control and unvaccinated HCP should physically distance from others.
It is important to note that if vaccination status cannot be determined, the safest practice is for all participants to follow all recommended infection prevention and control practices including maintain physical distancing and wearing source control.
SARS-CoV-2 Testing
- Asymptomatic HCP with a higher-risk exposure and patients or residents with prolonged close contact with someone with SARS-CoV-2 infection, regardless of vaccination status, should have a series of two viral tests for SARS-CoV-2 infection. In these situations, testing is recommended immediately and 5–7 days after exposure.
- People with SARS-CoV-2 infection in the last 90 days do not need to be tested if they remain asymptomatic, including those with a known contact.
- In healthcare facilities with an outbreak of SARS-CoV-2, recommendations for viral testing HCP, residents, and patients (regardless of vaccination status) remain unchanged.
- In nursing homes with an outbreak of SARS-CoV-2, HCP and residents, regardless of vaccination status, should have a viral test every 3-7 days until no new cases are identified for 14 days.
- Expanded screening testing of asymptomatic HCP should be as follows:
- Fully vaccinated HCP may be exempt from expanded screening testing. However, per recommendations above, vaccinated HCP should have a viral test if the HCP is symptomatic, has a higher-risk exposure or is working in a facility experiencing an outbreak.
- In nursing homes, unvaccinated HCP should continue expanded screening testing as previously recommended.
- For other healthcare facilities that are performing expanded screening testing for asymptomatic HCP who do not have a known exposure, vaccinated HCP can be excluded from such a testing program.
- Performance of pre-procedure or pre-admission viral testing is at the discretion of the facility. The yield of this testing for identifying asymptomatic infection might be lower among vaccinated patients because a growing body of evidence suggests that fully vaccinated people are less likely to have asymptomatic infection. However, these results might continue to be useful in some situations to inform the type of infection control precautions used (e.g., room assignment/cohorting, or personal protective equipment used).
The CDC recommendations for use of personal protective equipment remain unchanged. CDC’s definition of fully vaccinated and unvaccinated are:
Fully vaccinated refers to a person who is:
- ≥2 weeks following receipt of the second dose in a 2-dose series, or ≥2 weeks following receipt of one dose of a single-dose vaccine; there is currently no post-vaccination time limit on fully vaccinated status
- This guidance applies to COVID-19 vaccines currently authorized for emergency use by the Food and Drug Administration. Considerations for applying this guidance to vaccines that are not FDA-authorized include whether the vaccine product has received emergency approval from the World Health Organization or authorization from a national regulatory agency.
Unvaccinated refers to a person who does not fit the definition of “fully vaccinated,” including people whose vaccination status is not known, for the purposes of this guidance.
The CDC COVID-19 Infection Control after Vaccination can be accessed at: Updated Healthcare Infection Prevention and Control Recommendations in Response to COVID-19 Vaccination | CDC.
Issue:
Nursing facilities must remain vigilant against the spread of COVID-19. A critical strategy that can be taken to help decrease the spread of COVID-19 is the COVID-19 vaccination, along with other CDC recommendations to help reduce transmission of the virus. As more is researched and learned about the COVID-19 virus, healthcare personnel must stay up-to-date on the important changes and train all staff on the available information.
Discussion Points:
- Review your Infection Control Plan and your policy and procedure on the COVID-19 vaccination. Ensure that both include the most up-to-date information from the CDC.
- Train all staff on your Infection Control Plan and your COVID-19 policies for vaccination and prevention of the spread of the virus. Provide education about the changes in visitation and communal dining restrictions. Place proof of training documentation in each employee’s education file.
- Periodically audit to ensure that all staff are following your Infection Control Plan, and that staff are aware of the benefits and risks associated with the COVID-19 vaccination. Audit vaccine consent and administration rates and provide additional education where needed. Determine that visitation, use of personal protective equipment, and dining practices comply with CDC revised recommendations. Provide additional training if deemed necessary.
