Recently, LW Consulting, Inc. was invited to present a three-part series on the subject of infection control for the New Jersey Hospital Association (NJHA).
During the first presentation in November, our panel of experts received many excellent questions. The panelists reviewed the questions after the session and have provided their answers. We are pleased to share them for the edification of all and hope that you find the answers useful in your everyday operations.
In Part 1 of this series, we discussed questions regarding cleanliness and housekeeping. In Part 2, we discussed questions regarding N95s, masks, and respirator compliance. In the final Part of this series, Part 3, we will discuss questions that were asked regarding essential workers and visitation restrictions.
Please note – Some of the information is specific to New Jersey, but many items are consistent across state lines. If you have additional questions, we urge you to reach out to us at LW Consulting, Inc., and one of our experts can provide more specific information.
Question 1: “With visitation restrictions, what do we do with sub-acute patients in the facility that need to have family training prior to discharge and are being cut by insurance. For safe discharge the family must have hands on training for suctioning, transfer etc., but you cannot allow visitors because you have a positive TM or PT for the 14 days after a positive. Can you send them home? If not, who covers stay?”
Answer 1: Reach out to your local Department of Health (DOH) office and ask for guidance. While the understanding is that there needs to be hands on training for care giving at home, you may want to begin “training” through Zoom well prior to discharge. Additionally, you may want to appeal the discharge to the insurance company, if it is the patient who is testing positive. If it is the designated family member who has tested positive, they will need to identify a secondary person to receive the training. If no training can be done, look at alternative payment methods, or the patient will need to be charged privately.
Question 2: “On a former call they said we could have the requirements for an Infection Preventionist met by the CDC course. Do they also need 5 years of certification?”
Answer 2: If you chose to use someone who has had the experience for at least 5 years, you must have clear documentation of that experience. I would suggest that the individual also take the CDC course and obtain the certification as there is no charge for the on-line course.
Below is the information taken directly from State of New Jersey, Department of Health, Executive Directive NO. 20-026II. Required Core Practices for Infection Prevention and Control.
- Regardless of a facility’s current reopening phase, core infection prevention and control practices must be in place at all times. Maintaining core infection prevention and control practices is key to preventing and containing outbreaks and is crucial in ensuring the delivery of quality, safe care. In addition to the requirements in N.J.A.C. 8:39-20, the following practices shall remain in place even as LTCF’s resume normal activities, regardless of the facility’s current reopening phase:
Review the Core Infection Prevention and Control Practices for Safe Healthcare Delivery in All Settings – Recommendations of the Healthcare Infection Control Practices Advisory Committee at https://www.cdc.gov/hicpac/pdf/core-practices.pdf, and implement any guidance applicable to the facility.
- Facilities must educate residents, staff, and visitors about COVID-19, current precautions being taken in the facility, and protective actions. Facilities must encourage social distancing with physical separation.
- All facilities, except for facilities with ventilator-dependent residents, are required to have one or more individuals with training in infection prevention and control employed or contracted on a full-time basis or part-time basis to provide on-site management of the Infection Prevention and Control (IPC) program. The requirements of this Directive may be fulfilled by:
- An individual certified by the Certification Board of Infection Control and Epidemiology or meets the requirements under N.J.A.C. 8:39-20.2;
- A physician who has completed an infectious disease fellowship;
- A healthcare professional licensed and in good standing by the State of New Jersey, with five (5) or more years of infection control experience.
Question 3: “Do we have to print all Covid-19 test results weekly?”
Answer 3: As a good documentation rule of thumb—yes, documentation should be kept in hard copy. Anything submitted to the DOH needs to be kept in hard copy. I recommend keeping all documents filed by week and segmented for visitors, staff, and residents.
Question 4: “Can patients on quarantine leave the room for therapy (i.e. stairs and distance walking) or have therapy in the gym if full PPE is used, only one at a time, and disinfection when done?”
Answer 4: It is not recommended that a quarantined patient leave their quarantine area. Work with your therapy provider to formulate a treatment plan to have the therapy done in the quarantine area, and when quarantine is complete, move the therapy to other areas to accomplish stairs and long-distance walking.
Question 5: “It was mentioned that in Phase 1 non-essential people cannot come in and that includes Hospice aides. In my opinion, they would be considered essential.”
Answer 5: On page 30 of the directive, it is clearly indicated that non-essential personnel are those such as barber’s, hair stylists, outside volunteers, and activity groups.
As identified on pages 22, 23, and 24 of the directive, there are very specific details identified for end-of-life visits, compassionate care visits and essential caregiver visits. These visitors must have been provided an informed consent, must be screened, and details recorded prior to each visit. Visits should be on a limited basis.
Question 6: “Are lab technicians considered non-essential personnel?”
Answer 6: Beginning on page 17 of the directive (Section III, 2, ii), state healthcare workers, such as lab technicians, can enter the facility if provided the informed consent, they must be screened and not show any signs or symptoms of COVID-19 prior to entry.
Question 7: “If you have a vestibule, can you have family on one side of the glass and the resident on the other and have that still be considered outdoor visit?”
Answer 7: Anything that would be inside the doors of your facility would be considered an indoor visit. These visits should be limited to identified areas only and occur only during the appropriate “phases” of reopening.
Question 8: “How can you allow a compassionate care visit for a new admission if they are already in COHORT 4?”
Answer 8: Unfortunately, these visits cannot occur for those residents in a cohorting situation.
Question 9: “How do you continue outdoor visitation when it’s starting to get cold for the seniors? Is outdoor heating equipment acceptable?”
Answer 9: If the heating equipment is used in a safe manner for the visit, it could be part of your written plan. Limits on locations outdoors is necessary in order for the numbers of visitors to remain low. Remember to have the outdoor visits be in a location that is safe to navigate to and from.
Do you have more specific questions regarding essential workers, visitation or other environmental services? Contact Emile LeDoux, Senior Consultant, at 717-313-3120 or email ELeDoux@LW-Consult.com.