To protect our residents from widespread outbreaks and pursuant to New Jersey law N.J.S.A.2H-12.87 Water’s Edge Healthcare has developed and implemented an Outbreak Response Plan The staff at Water’s Edge will be educated in outbreak prevention and how to respond to an outbreak.
|Procedure: The Outbreak Plan addresses: Prevention, Assessment, and Mitigation of Infectious Diseases |
The facility conducts an annual risk assessment as part of the infection control program and the emergency management plan to identify, track, trend and implement prevention techniques to prevent disease outbreaks. If an infectious disease outbreak occurs the facility has disease specific interventions that are implemented to mitigate the outbreak and prevent the spread. If the disease is a novel organism the Infection Control Preventionist works closely with the NJDOH, CDC and CMS regarding actions to be taken.
Staff will be informed of disease specific symptoms to monitor for and the protocol for reporting. Ongoing and intensified assessment of all residents will be done to evaluate potential spread. This nursing assessment guidance will be established by the nurse leaders, infection control preventionist, medical director and nurse practitioner. Residents will be educated about symptoms to report to a nurse immediately should they occur. Telehealth evaluation of suspected infected residents should be considered to aide in exposure prevention. Staff will explain and provide reassurance and answer residents’ questions. Care plans will be updated to reflect the current needs of each affected resident during the outbreak period.
Transmission Based Precautions Protocol Transmission based precautions are followed based on the mode of transmission of the infectious organism. Staff receive education about standard, contact, droplet, and airborne precautions on hire and annually. The type of precautions used are specific to each disease. The facility maintains a list of common infectious diseases and the required precautions required to prevent spread. The type of precautions also affect visitation, equipment use, isolation requirements and resident, staff and family alerts.
Cohorting is the practice of grouping residents who are or are not colonized or infected with the same organism to confine their care to one area and prevent contact with other residents. If needed a cohorting plan will be implemented using three basic groupings:
Cohort A– Strict in-room isolation. Resident is Ill
Cohort B – Isolation – Resident is not ill but has potentially been exposed
Cohort C – Unaffected residents.
Resident is not ill and not exposed Communication Protocol Group notification of resident’s, families, visitors, vendors, volunteers, physicians and staff in the event of an outbreak of a contagious disease is conducted immediately. Notification includes provision of information regarding the type of outbreak, restrictions on visitation, educational materials, specific resident impacts, actions implemented to mitigate the spread of disease, and changes in routine daily care and services delivery. Group notification and outbreak updates and guidance will be posted on the facility web site based on the disease specific requirements and guidance from NJDOH and CDC. The Social Service and Activity departments will coordinate telephone, email, facetime, and skype visits during outbreaks. Nexus Connect, a notification assistance company has been contracted to assist in notification to resident’s POAs and families. Individual notification of residents, families and physicians is also completed for each individual that is diagnosed with the organism. Residents and staff will be notified of any outbreak, the extent of the outbreak within the facility, actions implemented to mitigate an outbreak, notification of any restrictions, education in easy to understand language, and be provided with required personal protective equipment if required. Administration recognizes the importance of open communication and will inform residents, families, significant others and guardians of the outbreak concerns and how this affects “everyday life” at the facility, e.g. visiting hours, meals activities, and limited access to the facility or a designated area in the facility. A phone tree notification will be established by the Administrator and the Social Service department to inform all residents’ primary contacts. Written notification mailings will be considered. Email notifications will be done if email addresses are available. Social Media, particularly the facility’s Face Book page will post notifications and updates. Facility notifications will be posted at the facility entrance. Resident rights and privacy will be maintained with all of the above notifications.
Housekeeping & Laundry Protocols Disease specific cleaning and disinfecting protocols are in place to ensure facility cleanliness and mitigation of spread of infectious organisms. The facility maintains a supply of cleaning products approved by EPA for cleaning and disinfecting. Housekeeping staff follow written protocols beyond general cleaning that are disease specific including increasing cleaning passes, increased cleaning of high touch surfaces, and purchasing of additional cleaning products as needed that are disease specific. Laundry will also be handled as required based on the specific disease organism.
Staffing protocols address work restrictions, alternative plans to staff if shortages occur, and use of personal protective equipment to protect staff and residents during an outbreak to minimize the spread of infection and ensure resident care needs are met. Assigned tasks will be identified/prioritized by department directors that can be temporarily eliminated of modified during an outbreak should a staffing shortage occur. The facility will make every effort to have routine employee unit assignment.
Employee Monitoring Protocol
All employees are monitored for signs of symptoms when they report to work. Employees are required to notify their supervisor or director if the develop symptoms. Employees are required to notify their supervisor or director of any potential exposure. Employees that become symptomatic at work will be removed from duties and given guidance on appropriate medical follow up. This may include testing. Sick leave policies will be followed but may be modified to allow flexibility and consistency with public health guidance. Return to work will be determined by standards set at the CDC and are disease specific. The medical director, Director of Nursing, Infection Preventionist and Administrator will enforce these guidelines
Employees will receive outbreak disease education to dispel concerns and prevent unwarranted call outs. Re- education will be given to all employees related to infection control practices inclduing handwashing, personal hygiene, donning and doffing PPE, and disease specific infection control information
Laboratory and Radiology Testing Protocols
Disease specific testing protocols are implemented to quickly identify all affected individuals, initiate infection control actions and implement treatments. Lab and radiology testing are disease specific and these decisions are guided by CDC and NJDOH directives
Public Health Reporting Protocol
All infectious disease outbreaks are reported to public health officials in accordance with applicable laws and regulations. Public health officials also provide the facility with directives and guidance during an outbreak and provide support, guidance, access to testing and specific PPE if needed. Facility administration monitors updates from regulatory agencies including CDC, NJDOH and CMS. Communication with public health agencies is conducted as required and includes reporting outbreak statistics and a daily line list of affected individuals. The Administrator, Director of Nursing, Infection Preventionist and department directors will meet daily and review all directives to ensure implementation as required. Water’s Edge abides by all laws and regulations. Outbreak concerns are immediately reported to the City of Trenton Health Department, Department of Health, Ombudsman (if applicable) and any other government agencies that may be required r/t the outbreak.
Resident Quality of Life Protocol
Water’s Edge recognizes the importance of filling the resident’s lives with activities and socialization. We attempt to prevent loneliness and know that humor, fun and mental activity are treatments and kindness that can heal. Maintaining quality of life is very important during a restriction on visitors and group activities. Keeping up morale and using distraction to reduce stress is equally important during a crisis as providing excellent physical care. Alternate visitation protocols will be implemented consistent with the type of outbreak and public health guidance. Whenever possible virtual visits and phone calls will be used to encourage family and friends contact with residents. Activity programs will be tailored to any restrictions required to contain the spread of infection. Meals may be required to be served in rooms instead of in a communal dining area.
Supply Inventory Protocol
PAR levels are maintained and reviewed by the Administrator, Director of Nursing, and Infection Control Preventionist in the event of an outbreak. PPE supplies, food, cleaning products, disposable resident care products, and equipment needs are monitored weekly and replaced based on established levels. In the event of a communicable disease supply inventory needs may be increased and will be purchased from our established vendors. If any supply needs cannot be met/purchased through our established vendors then administration will inform the corporate staff and will contact the local and NJ State Department of Health for guidance.
Signs are posted at all entrance doors regarding visiting changes, safety, handwashing and germ prevention. Signs specific to any outbreak will also be posted on all entrance doors with directions for visitors. Signs will be placed on all resident unit doors if a unit is closed to visitation. Visitors and vendors will sign in with the receptionist (barring a moratorium on visits facility or unit specific). Completion of a brief questionnaire may be required before being allowed to visit. Compassionate care and end of life visits may be permitted during outbreaks in compliance with CDC and NJ Department of Health guidance. Visitors will be escorted to their loved one, provided with needed PPE and instructed in use, and proper isolation requirements will be maintained.
Lessons Learned from COVID19
The following changes have been made to facility infection control protocols and operations as a result of the COVID19 pandemic: Water’s Edge has instituted a respiratory protection program in compliance with revised OSHA regulations. This program includes fit testing staff for the use of N95 respirator masks. Water’s Edge has revised educational materials to reflect new guidance from CDC regarding donning and doffing and disposal of PPE. All employees have received education and the materials have been included in the facility infection control program materials.Water’s Edge PPE use and burn rates are now calculated daily and statistics are reported as required on the NJHA portal and on the federal NHSN portal. Water’s Edge has now implemented an emergency stockpile of PPE in the event adequate supplies cannot be purchased.Water’s Edge reports disease outbreak statistics as required on the NJHA portal and on the federal NHSN portal.Water’s Edge re-evaluated all cleaning and disinfecting products and protocols and made appropriate changes to address COVID19.Water’s Edge modified communication protocols and entered into contracts with vendors to ensure open and accessible communication within and outside the facility during a ban on visitation.Water’s Edge staff re-imagined resident activities and meals to ensure safety and minimize the risk of infection while maintaining safe social interactions.Water’s Edge implemented a facility-wide cohort plan that required creation of cohort specific units to contain the spread of infection.Water’s Edge contracted with an Infection Preventionist consultant to assist the facility to review the infection control program and assist with outbreak prevention and management
*More detailed information and procedures are available at the facility or by request.