Outbreak Response Plan

October 27, 2021

MANUAL: NURSING

FACILITY: ACTORS FUND HOME

DATE: REVISED SEPTEMBER 10, 2020
REVISED SEPTEMBER 28, 2021
REVISED SEPTEMBER 12, 2022

POLICY: Outbreak Response Plan

POLICY #:

POLICY

The protocol for isolating and cohorting infected and at risk residents in the event of an outbreak of a contagious disease until the cessation of the outbreak. The plan was done in accordance with the current guidelines from the Centers for Medicare and Medicaid (CMS), Centers for Disease Control (CDC), state and local guidance for infection prevention for the duration of the COVID-19 pandemic. The Outbreak Plan was developed based on the requirements outlined in ED 20-026, the Directive for the Resumption of Service in Long Term Care Facilities (LTC).

PURPOSE

Prevention and control of an outbreak of a contagious disease until the cessation of the outbreak.

PROCESS

THE MAJOR ACTIVITIES OF THE PROGRAM ARE:

Core Practices of Infection Prevention

The Infection Control Program is comprehensive in that it addresses detection, prevention and control of infections among residents and staff.

SURVEILLANCE OF INFECTIONS
There is on-going monitoring for infections among residents and staff and subsequent documentation of infections that occur. Routine monitoring of residents and staff to quickly identify signs of a communicable disease that could develop into an outbreak.
IMPLEMENTATION OF CONTROL MEASURES
Prevention of spread of infections is accomplished by use of Standard Precautions, Transmission Based Precautions and other barriers, appropriate treatment, and follow-up, and employee work restrictions for illness.
PREVENTION OF INFECTION
Staff and resident education is done to focus on risk of infection and practices to decrease risk. Policies, procedures and aseptic practices are followed by personnel in performing procedures and in disinfection of equipment. Immunizations are offered as appropriate to residents and personnel to decrease the incidence of preventable infectious diseases.

DIVISION OF RESPONSIBILITIES FOR INFECTION CONTROL ACTIVITIES

The Actors Fund Home has created an Infection Control Committee which will be ultimately responsible for planning, monitoring, evaluating, investigation, control, and prevention of health-care associated infections (HAIs). The Team will develop a system of care that promotes sound and scientific infection prevention principles and practices. Partnering with the Medical Director, Administrator, Assistant Administrator, DON, and Infection Prevention Nurse (IPN) are Infection, Preventionist Consultant, Ms. Lucille Plantemoli and Infectious Disease Doctor, Dr. Ashwin Jathavedam. The Infection Prevention Committee will make rounds and meet on a quarterly basis, and more frequently if necessary. The Infection Prevention Committee reports to the Governing Board.

INFECTION PREVENTION NURSE

Responsibility is delegated to the Infection Prevention Nurse (IPN) to carry out the daily functions of the Infection Control Program. These functions are described in the IPN job description. The IPN has knowledge and interest in Infection Control.

AUTHORITY

The Infection Prevention Committee can take immediate and appropriate action to correct and deficiencies relating to infection control that creates hazardous conditions.

REPORTING

The IPN prepares infection reports and presents them to the Infection Prevention Committee. Problems are identified and actions are planned for resolution and presented to the Committee.

RESPIRATORY PROTECTION PROGRAM

The facility has developed and implemented a Respiratory Protection Program that complies with the Occupational Safety and Health Administration (OSHA) respiratory protection standards for employees. The program will include medical evaluations, training and fit testing.

In order for the facility to meet the requirements of the Executive Directive No. 20-026, the facility will submit to the Department via email to:

LTC.DiseaseOutbreakPlan@doh.nj.gov

An Infection Control Employee attestation on facility letterhead from the administrator with the facility name and license number stating the facility has implemented a respiratory protection program that complies with the OSHA respiratory protection standard for employees.

PPE STOCKPILING/INVENTORY

The facility will have an adequate emergency stockpile of PPE, essential cleaning and disinfection supplies so that staff, residents and family/visitors can adhere to recommended infection prevention and control practices.

The facility has essential cleaning and disinfection supplies on hand in the event of a supply chain disruption.

If the facility is forced to use the PPE stockpile due to an emergency, the facility is required to re-stock and resubmit the attestation statement indicating the restocking in accordance with Executive Directive 20-026: LTC.PPEStockpile@doh.nj.gov.

REPORTING TO THE NHSN PROGRAM

The facility is required to report, at minimum twice per week, COVID-19 cases, facility staffing, and supply information to the National Healthcare Safety Network (NHSN) Long Term Care Facility COVID-19 Module:

https://www.cdc.gov/nhsn/ltc/covid19/index/html.

Counts of residents and facility personnel with suspected and laboratory positive COVID-19.
Counts of suspected and laboratory positive COVID-19 related deaths among residents and staff.
Resident beds and census.
Staffing shortages.
Status of personal protective equipment (PPE) and hand hygiene supplies.

STAFFING STRATEGY

The facility will have no staffing shortages and will not operate under a contingency nor crisis staffing plan. (Required by NJDOH E.D. 20-026.) The facility will secure additional staff in the event of a new COVID-19 or other infectious disease outbreak.

COHORTING/RESIDENT PLACEMENT

Room Assignment/Placement:

Private Room preferred.
Cohort – When a private room is unavailable, a group of residents who are or are not colonized or infected with the same organism will be confined for their care to one area and to prevent contact with other residents.
Place with an individual where no invasive procedures are performed or use of invasive equipment (e.g., catheters).
Use disposable equipment (i.e., stethoscopes, blood pressure cuffs, etc.)
A “STOP SIGN” will be placed at the door to alert staff and visitors to see the nurse before entering.
Personal Protective Equipment (gown, gloves, hair nets, shoe covers, etc.) are available on the unit.

PPE REQUIREMENTS

Instruct staff, resident, his/her representative, and family/visitors regarding precautions and use of personal protective equipment (PPE).

Staff will put on gown, N-95, goggles/face shield, and gloves upon entry to room of infected individual. Handle items contaminated with respiratory secretions (i.e., tissues) with gloves.

Change personal protective equipment (PPE) and perform hand hygiene between contact with residents in the same room.
Before leaving a patient/resident care environment:
- Remove gloves in the patient/resident’s room.
- Remove gown in the patient/resident’s room.
- Perform hand hygiene prior to leaving patient/resident’s room.
- Exit the patient/resident’s room.
- Remove eye protection.
- Remove mask/respirator.
- Perform hand hygiene.
- Put on source control.

GLOVES AND HANDWASHING:

Review standard precautions.
During care, if gloves contact highly infectious materials (e.g., feces, wound drainage, etc.), change them.
After removing gloves, wash hands with antimicrobial agent for at least 20 – 30 seconds (Refer to Handwashing Policy).

GOWN:

Review standard precautions. Follow Personal Protective Equipment (PPE) Protocol.
Wear a gown when you anticipate clothing will be contaminated by the individual or contact with environmental surfaces or items in the individual’s room.
When removing the gown follow Personal Protective Equipment (PPE) Protocol.

MASKS:

N95 respirator masks will be used in the facility by staff to reduce the wearer’s exposure to airborne particles, from small particle aerosols to large droplets during aerosol generating procedures as outlined by the Centers for Disease Control.

TRANSPORT:

If an individual leaves their room, ensure that precautions are taken to minimize the risk of transmission of microorganisms (e.g., cover wounds, personal hygiene, and respiratory masks).
- Limit transport of such residents to essential purposes such as diagnostics and therapeutic procedure that cannot be performed in the resident’s room. Provide cover/containment of infected area when the resident is outside of his/her room. Residents will follow respiratory hygiene/cough etiquette. Staff will assist the resident with hand hygiene as needed.
- b. Notify the healthcare provider in the receiving area of the impending arrival of the resident and of the precautions necessary to prevent transmission; and
- For residents being transported outside of the facility, inform the receiving facility and the medi-van or emergency vehicle personnel in advance about the type of transmission-based precautions being used.

Dedicate personal care equipment (thermometer, blood pressure cuff, stethoscope, etc.) or use disposable equipment when available.
- If use of common equipment is unavoidable, clean and disinfect item before use with another resident.
Clean and disinfect frequently touched surfaces daily (i.e., doorknobs, bed rails, over-bed tables).
Once the resident is no longer a risk for transmitting the infection (i.e., duration of the illness and/or can contain secretions) discontinue precautions.

EQUIPMENT:

Environmental Services Department staff will thoroughly clean and disinfect equipment.

At a minimum, gloves will be worn during all cleaning and disinfection of equipment.
When appropriate, the use of other barrier type personal protective equipment (PPE) will be used.
Contaminated with blood or body fluids.
When possible, dedicate the use of non-critical equipment to a single individual.
If use of common equipment is unavoidable, thoroughly clean and disinfect using an EPA approved disinfectant Wipe, i.e., Oxivir Wipes, according to manufacturer’s instructions and facility’s policies and procedures.
According to the regular cleaning schedule.

TRAINING:

The facility will educate residents, staff, and family/visitors about COVID-19, current precautions being taken in the facility, and protective actions. The facility will train and provide staff with all recommended COVID-19 PPE, to the extent PPE is available, and consistent with CDC guidance on optimization of PPE.

TRANSFERS:

The facility shall implement universal source control for family/visitors and staff in the building. All residents, whether they have COVID-19 symptoms or not, must practice source control when around others (surgical mask) in accordance with CDC guidance.
The facility will separate COVID-19 positive and negative residents in accordance with NJDOH guidance. A resident is considered recovered from COVID-19 only after they have met the criteria for discontinuation of isolation as defined by the NHJDOH and CDC guidance.
The facility will continue to follow current NJDOH orders, guidance and directives on admissions and readmissions. Facilities may receive residents who were tested prior to admission transfer or shortly thereafter, in accordance with NJDOH guidance. The facility will take appropriate actions on the results including, but not limited to, the guidance below.
1. COVID-19 diagnostic test results must be provided (in addition to other pertinent clinical information to the receiving facility for any transferred resident upon receipt of lab test.
2. COVID-19 diagnostic test results must be provided (in addition to other pertinent clinical information to the receiving facility for any transferred resident upon receipt of lab test.

COVID-19 TESTING PLAN FOR ALL STAFF AND RESIDENTS

RESIDENT AND STAFF TESTING

Testing Procedures and Frequency:

Residents, regardless of their vaccination status will be tested based on the CDC Guideline of February 2, 2022. The resident will have a series of two viral tests, one not before 24hr. after exposure and if negative 5-7 days after exposure.
Staff will be tested initially as outlined in the CDC Guideline of February 2, 2022, once after exposure and then at day 5-7 if negative. Following that, unvaccinated staff will be tested based on the CDC Community Prevalence Rate.
Post-testing protocols for residents such as cohorting of residents and separation of those with laboratory confirmed COVID-19 infection from others. (Refer to Cohorting above)
Procedures to obtain staff authorizations for release of laboratory test results to the facility as to inform infection control and prevention strategies.
Work exclusion of staff who test positive for COVID-19 infection, refuse to participate in COVID-19 testing, or refuse to authorize release of their testing results to the facility, until such time as such staff undergoes testing and the results of such testing are disclosed to the facility.
Return to work protocols after home isolation for staff who test positive will be based on the Guideline for COVID-19 Diagnosed and/or Exposed Healthcare Personnel, February 17, 2022.
Address staffing (including worker absences).

REPORTING

The facility will submit the following information in a prescribed format through the portal designated by the Office of Emergency Management (“OEM”) and be consistent with available CDC and DOH public health guidance:

Testing dates;
Numbers of staff and residents that have been tested.
Staff authorizations for release of laboratory test results to the facility so as to inform infection control and prevention strategies.
Work exclusion of staff who have tested positive for the COVID-19 infection, refuses to participate in COVID-19 testing, or refuse to authorize release of their testing results to the facility, until such time as such staff undergoes testing and the results of such testing are disclosed to the facility.
Protocols for returning to work after home isolation for staff who tested positive.
Plans to address staffing (including worker absences) and facility demands due to the outbreak.
Aggregate testing results for the staff and residents populations;
Any other information requested by DOH.
Any and all records related to COVID-19 testing protocols and implementation by the facility shall be made available to DOH, upon request.
If a resident refuses to undergo COVID-19 testing, then the facility shall treat the resident as a “Person Under Investigation”, make a notation in the resident’s chart, notify any authorized family members or legal representatives of this decision, and continue to check temperature on the resident at least twice per day. Onset of temperature or other symptoms consistent with COVID-19 require immediate cohorting. At any time, the resident may rescind their decision not to be tested.
A line-listing of resident testing is kept in an Outbreak situation and an ongoing line-listing is kept of staff testing for those staff who are unvaccinated and have a religious or medical exemption.

RESIDENT/STAFF ELIGIBILITY

Residents and staff who has or may have been exposed to SARS-COV-2 within the incubation period for COVID-19 (pursuant to current guidelines), and who meets one of the following conditions:

Resident/Staff who had close contact (within 6 feet for at least 10 minutes) with someone who tests positive for COVID-19 (with or without symptoms).
Healthcare Facilities Workers (with or without symptoms).
Resident/Staff with symptoms of COVID-19 infections, including fever, cough, shortness of breath, chills, muscle pain, recent loss of taste or smell, vomiting or diarrhea and/or sore throat.
Populations identified by the Department of Health for surveillance purposes at the discretion of the Department.
Resident/Staff without symptoms of COVID-19 infection who are prioritized by health departments or clinicians, for any reason.

INFORMATION ON COLLECTING THE SPECIMEN:

Prior to collecting the specimen from the Resident/Staff, the tester shall provide information to the patient receiving the testing, which shall include but is not limited to the following:

Information on how and when to obtain test results.
Information for contacting the local health official with the jurisdiction where the resident/staff resides.
Information on next steps to for the resident/staff to take, including:
Information on obtaining follow-up medical care or to address questions about a diagnosis if the resident/staff tests positive for COVID-19;
Information about actions to be taken in accordance with guidance as issued and/or amended by the Centers for Disease Control and Prevention (“CDC”) and/or New Jersey Department of Health.

To identify individuals that are asymptomatic to ensure that they remain negative or non- detected with the SARS-CoV-2/ 2019-nCoV. To ensure that the facility remains COVID-19 free and decrease the spread of the Coronavirus.

The facility resident(s) and staff with symptoms or signs of COVID-19 must be tested immediately — regardless of vaccination status — under updated testing requirements for facilities by the Centers for Medicare & Medicaid Services.
COVID-19 testing is done weekly to 100% to all the residents in the facility. Testing is done through Acculabs. Each resident are swabbed nasally, unless a resident is able to produce and provide a saliva sample.
COVID-19 testing is done weekly to 100% to all the staff in the facility. Testing is done through New Bridge Medical Center. Each staff produce and provide a saliva sample for testing unless they prefers the nasal swab.
All nasal swabs results are received within 24-48 hours and the saliva results are received within 48-72 hours.
All unvaccinated residents and staff will be tested three times a week by one PCR Test and two Antigen Tests. The facility will follow the CMS Interim Final Rule (IFC), CMS-3401-IFC for routine testing intervals by County COVID-19 Level of Community Transmission as follows:

Level of COVID-19 Community Transmission	Minimum Testing Frequency of Unvaccinated Staff
Low (blue)	Not recommended
Moderate (yellow)	Once a week*
Substantial (orange)	Twice a week*
High (red)	Twice a week*

*”This frequency presumes availability of Point of Care on-site at the facility or where off-site testing turnaround time is <48 hours.”

The facility will test all unvaccinated staff at the frequency prescribed in the Routine Testing table based on the level of community transmission reported in the last week.

If the level of “community transmission” increases to a higher level of activity, the facility will continue testing staff at the frequency.
If the level of “community transmission” decreases to a lower level of activity, the facility will continue testing staff at the higher frequency level until the level of community transmission has remained at the lower activity level for at least two (2) weeks before reducing the frequency.

RESULTS:

In the event a resident result is positive (+), the resident is immediately put on isolation. Resident’s Primary MD, Medical Director, family are made aware of the result and next steps.
Resident is then swabbed 3 times to have the following done:
1. 1^st swab – BD Veritor Antigen testing done in house and result is read in 15 minutes.
2. 2^nd swab – Abbott Binax Antigen testing done in house and result is read in 15 minutes.
3. 3^rd swab – is sent to lab company, Acculabs for a stat PCR test.
The resident’s MD and family are made aware of the above results.
The resident will continue to be monitored every shift for any signs and symptoms of the Coronavirus infection.

INTERPRETATION OF RESULT:

In the event that all 3 above swabs (BD Veritor Antigen, Abbott Binax Antigen, PCR from Acculabs) comes back negative (-), the first test is deemed to be a false positive and resident is considered to be negative. Isolation Precaution will be discontinued.
If the Antigen test comes to be positive (+) with another positive (+) PCR test, the resident is considered to be positive (+). Resident will continue his/ her isolation, results will be relayed to the MD and family. Facility will report result to the DOH/ CDC.
If the Antigen test comes to be negative (-), and one of the PCR test is positive (+), the resident is deemed positive (+). Resident will continue his/ her isolation, results will be relayed to the MD and family. Facility will report result to the DOH/ CDC.
If the Antigen test comes positive (+) and PCR test are negative (-), the resident is considered negative and had a false positive on the initial test.

INTERPRETATION OF RESULT FOR STAFF:

In the event a staff member is positive on their initial test, the employee is sent home immediately. They are taken off the schedule for at least 10 days.
The staff is asked to self-quarantine per facility’s policy and contact their primary MD to notify them of the positive result and any further treatment.
Once staff is cleared by their primary MD to return to work, and they are asymptomatic, the staff has to abide by the policy’s baseline testing requirement which is 2 negative COVID-19 results within 3-7 days.
Once 2 negative results are obtained, the staff is able to report to work.
Any staff that have signs and symptoms of COVID-19 and refuses testing are prohibited from entering the building until the return to work criteria are met.
In addition, ANY staff member that takes a vacation and is off for more than 5 days we will need to get a PCR test to clear your return.
Residents or resident’s representative may exercise their right to decline COVID-19 testing in accordance with the requirement under 42 CFR 483.10 (c) (6). Any resident who has signs and symptoms of COVID-19 and refuses testing are placed on Transmission Based Protocols (TBP) until the criteria for discontinuing TBP have been meet.

CONDUCTING TESTING

The facility will obtain an order from the resident’s physician or nurse practitioner for laboratory services for the resident, which includes COVID-19 testing.

Testers may collect a specimen for a SARS-COV-2 molecular test approved by the U.S. Food and Drug Administration (“FDA”), authorized by the FDA through an Emergency Use Authorization or approved by the New Jersey Clinical Laboratory Improvement Services as permitted by the “FDA”.
Preparation to collect a specimen:
1. Ensure correct testing materials according to manufacturer instructions and/or the laboratory who will be performing the test.
2. Ensure appropriate personal protective equipment for tester to administer the test such as gloves, gowns, N95 or higher respirator (or surgical mask should a respirator not be available) and eye protection (goggles or face shield).
Instruction to collect a specimen
1. By licensed healthcare provider, or trained, supervised personnel.
2. Follow manufacturer-specific and/or laboratory-specific instructions for specimen collection.
3. Follow CDC guidelines for Collecting, Handling, and Testing Clinical Specimens for Resident/Staff for Coronavirus Disease 2019, as amended and supplemented.
The laboratory conducting a SARS-COD-2 molecular test on a specimen collected shall report the test results to the facility.
Follow-up:
1. Test results must be reported to the resident/staff by a representative of the testing location as soon as possible but no later than 2 days after the testing location’s receipt of the test results. A positive result requires self-isolation per New Jersey Department of Health or local health department recommendations.
2. Positive and negative results must be reported by the laboratory processing the test results via the New Jersey Department of Health’s Communicable Disease Reporting and Surveillance System or other methods prescribed by the New Jersey Department of Health.

(New Jersey Department of Health Standing Order for COVID-19 Testing – Control Number: 2020-01)

NOTIFICATION OF RESTRICTED AND LIMITED VISITS:

COMMUNICATION

The facility shall communicate through multiple means to inform individuals, including non-essential healthcare personnel, of the visitation restrictions, such as through signage at entrances/exits, letters, emails, phone calls, and recorded messages for receiving calls.

VISITATION

The Actors Fund Home has sought ways to permit family/visitors under certain well-defined circumstances. In compliance with the State of New Jersey Department of Health and CDC. The Actors Fund Home has established a policy with controlled parameters that will help continue to protect our residents from potential exposure to coronavirus while remaining in compliance.

Upon arrival family/visitors will need to be tested, and as long as the test results are negative, the family/visitors will be asked to sanitize their hands and will need to wear a “tight fitting mask” which is a surgical mask and not a cloth mask, as PPE requirements.

FULLY VACCINATED FAMILY/VISITORS:

The family/visitors will be allowed to sit next to the resident, engage in physical contact with the resident and hold the resident’s hand.

“Fully vaccinated” means 14 days post your last vaccine.

UNVACCINATED FAMILY/VISITORS:

If family/visitors are unvaccinated or not fully vaccinated yet, the family/visitors will continue to be required to wear full PPE and must remain socially distant (at least 6 feet) from the resident.

The family/visitors will not be able to have any physical contact with the resident at this time.

If at any point the family/visitors does get vaccinated and moves to the fully vaccinated category, the family/visitors will let the screener know and produce the FDA Vaccination Card or show Docket app information so Actors Fund Home can keep the information on file.

PURPOSE

Balancing COVID-19 safety and visitation restrictions with the well-being of residents in the facility is an urgent priority for the Actors Fund Home

We recognize that isolation has serious impact on the health and wellbeing of our residents. Until now, the focus on keeping residents connected with family/visitors has centered on technology (i.e., Zoom, FaceTime, etc.), however this does not fully substitute for in-person visits. The Actors Fund Home believes the risk of COVID-19 transmission in our facility and the need for family/visitors interactions can be balanced under the following:

PROCESS

The facility shall screen and log all family/visitors entering the facility and all staff at the beginning of each shift.

The facility will actively screen all staff/vendors/family/visitors entering the building (except EMS personnel) for signs/symptoms of COVID-19 or exposure to persons with confirmed COVID-19. All visitors will have a Rapid Covid-19 Test.

Screening will include:

Temperature checks including subjective and/or objective fever equal to or greater than 100.4 F.
Family/visitors and staff will be asked to complete the sign-in process on the Accushield Kiosk, which will prompt you to answer the COVID-19 exposure questions. You will be screened by one of our nurses who will take your temperature and evaluate you for other sign and symptoms of COVID-19. Potential exposure which shall include at a minimum:
1. Whether in the last 14 days, the family/visitors has had an identified exposure to someone with a confirmed diagnosis of COVID-19, someone under investigation for COVID-19, or someone suffering from a respiratory illness.
2. If the family/visitors has been diagnosed with COVID-19 and has not yet met criteria for the discontinuation of isolation per guidance issued by NJDOH and CDC.
3. Whether in the last 14 days, the family/visitors has returned from a state on the designated list of states under the 14-day quarantine travel advisory.

The facility will observe anyone entering the building for any signs or symptoms of COVID-19, including but not limited to:

Chills;
Cough;
Shortness of breath or difficulty breathing,
Sore throat;
Fatigue;
Muscle or body aches;
Headache;
New loss of taste or smell;
Congestion or runny nose;
Nausea or vomiting; or
Diarrhea.

Upon screening, the facility will prohibit entry in the building for those who meet one or more of the following criteria:

If a family/visitors exhibits signs or symptoms of an infectious communicable disease, including COVID-19, fever greater than 100.4, chills, cough, shortness of breath or difficulty breathing, sore throat, fatigue, muscle or body aches, headache, new loss of taste or smell, congestion or running nose, nausea or vomiting, or diarrhea.
In the past 14 days, has had contact with someone with a confirmed diagnosis of COVID-19, or someone under investigation for COVID-19, or someone ill with respiratory illness.
In the past 14 days, if the family/visitors has returned from a designated state under the 14-day quarantine travel advisory.
If a family/visitors has been diagnosed with COVID-19 and not yet met criteria for the discontinuation of isolation per guidance issued by the NJDOH.

The facility will establish a designated area for family/visitors to be screened that accommodates social distancing and infection control standards. Family/visitors will be provided with the visitation guidelines upon screening. The facility will provide graphics to assist residents and family/visitors in maintaining social distancing and infection control standards.

Indoor Visits – Compassionate/End of Life Visits

No more than two (2) family/visitors are permitted at one time per resident. The facility will use appointments in order to limit the number of family/visitors inside the building at one time.

When a family/visitors undergoes screening and is permitted to enter the building, the facility will:

Restrict a family/visitors from entering the facility if they are unable to demonstrate the proper use of infection prevention and control techniques. All visits will be in the designated outdoor areas only, weather permitting.
Any resident suspected or confirmed to be infected with COVID-19, or under quarantine, will not be allowed family/visitors. This includes any resident under isolation protocols and any new or re-admitted residents. Once the isolation period has been completed, and only after 2 negative COVID-19 test results, or isolation will be discontinued if the resident is asymptomatic at day 10 (without fever for 24 hours), will a resident be allowed to have family/visitors.
Every visit must be approved by the resident. The facility has notified residents about the procedures. Residents will be required to wash their hands prior to any visit and wear a face covering during the outdoor visit.
All family/visitors must be healthy and not be experiencing any signs of being sick. If you have any signs or symptoms of being sick, you will not be permitted to visit the resident. If you have tested positive for COVID-19, you must have been retested and receive at least 2 negative test results before coming to the facility.
Once the family/visitors arrives, they will be screened by one of our nurses who will take your temperature and evaluate you for other signs and symptoms of COVID-19.
Once the family/visitors arrives, we ask that you complete the sign in process on the Accushield kiosk, which will prompt you to answer the COVID-19 exposure questions. You will be screened by one of our nurses who will take your temperature and evaluate you for other signs and symptoms of COVID-19.
Once the family/visitors(s) are approved, the family/visitors will be given personal protective equipment - “PPE” - that must be worn at all times. This will include a face covering, disposable gown and a pair of gloves. Also, the family/visitors will be asked to sanitize your hands before wearing your gloves. PPE must be worn at all times during your visit. At this time, if the family/visitors cannot wear the necessary PPE, you will not be allowed to visit.
The facility asks that the family/visitors arrive 20 minutes before the scheduled visit. If the family/visitors are late, we will do our best to accommodate the visit(s), but there is a chance the facility will need to cancel the visit and reschedule it.
If the family/visitors are fully vaccinated with the Covid-19 vaccine, the family/visitors will be asked to bring the facility the original FDA card that the family/visitors received during their vaccinations. “Fully vaccinated” means 14 days post the family/visitors last vaccine. The facility will make a copy of the family/visitors card and keep it on file. The family/visitors will NOT need to bring this card every time. Once we have cleared the family/visitors on your first visit, you will not need to present the card again.
Once tested and approved, the family/visitors will be taken to a designated area to meet with the resident. The Actors Fund staff will bring the resident from the facility to meet with the family/visitors. The family/visitors will be required to social distance and maintain a 6 foot distance from the resident.
An Actors Fund employee will be designated to monitor the area to ensure appropriate and safe social distancing, and that appropriate PPE is being used by the family/visitors and resident.
A resident will be allowed the maximum of 2 family/visitors at one time. If the family/visitors are unvaccinated AND NOT FROM THE SAME HOUSEHOLD, they will be required to maintain at least 6 feet between themselves and the resident.
There will be absolutely NO drinking or eating during these visits. Family/visitors may bring items for the resident but will be required to leave those items at the screening area.
Visits will be limited to 30 minutes, and will start at the top of the hour and end at the half hour. The family/visitors will be ask to arrive at least 20 minutes before their appointment to allow time for screening and donning of PPE. When the family/visitors 30 minute visit is over, the family/visitors will be asked to leave the facility and will be escorted out. The resident will be escorted back into the facility by staff.
The family/visitors and their loved one will be required to sign a document stating that the family/visitors are aware of the possible dangers of exposure to COVID-19 and that the family/visitors are their loved ones are both willing to abide by the rules and regulations set forth by The Actors Fund Home for outdoor visitation.
Should a family/visitors have any signs or symptoms of COVID-19 or test positive within 14 days of a visit to the facility, they will be required to immediately notify the Administrator, Jordan Strohl. His cell phone is 201.906.6392.
At this time, all family/visitors must be at least 21 years or older.

The facility will advise anyone entering the facility to monitor for signs and symptoms of COVID-19 for at least 14 days after exiting the facility. If symptoms occur, the facility will advise the family/visitors to self-isolate at home, contact their healthcare provider, and immediately notify the facility of the date they were in the facility, the individuals they were in contact with, and the locations within the facility they visited. The facility will immediately screen the individuals of a reported contact, and take all necessary actions based on any findings.

The facility must receive informed consent from the family/visitors and the resident in writing that they are aware of the possible dangers of exposure to COVID-19 for both the resident and the family/visitors and that they will follow the rules set by the facility in regard to visitation. The facility must receive a signed statement from each family/visitors and resident (if the resident is unable to consent then the consent needs to signed by the authorized representative) with a copy provided to the family/visitors and resident, that they are aware of the risk of exposure to COVID-19 during the visit, that they will strictly comply with the facility policies and procedures during visitation, and that the family/visitors will notify the facility if they test positive for COVID-19 or exhibit symptoms of COVID-19 within 14 days of the visit.

We understand there will be times when the rates in the community for Covid-19 will change and increase. During those times, the Actors Fund Home will be more protective of residents going out. We also realize that at times the numbers will be stable, and Covid-19 will not be prevalent throughout the community. The facility will adhere to the most current CDC and the NJDHSS Infection Prevention protocols for Covid-19 in LTC. The facility will monitor cases through the CDC Community Transmission Levels.

Our goal is to prevent our residents from getting Covid-19, and the facility from going into Outbreak; and at the same time, we want to accommodate the social and emotional needs of the people who live here. We have determined that residents leave the facility for two reasons.

Medically Necessary Reason - a resident going out to a medical appointment, to the emergency room or to an outpatient procedure. A nurse will perform a risk assessment on the resident when they return to the facility to determine if the resident needs to quarantine. As part of the risk assessment, a resident’s vaccination status will be considered. If the resident is not up to date with their vaccinations, a 5 -7 day quarantine, on Transmission Based Precautions (TBPs) will be necessary to ensure that they are not bringing Covid-19 into the facility which could place other residents at risk. The resident may be taken off TBPs if viral testing is negative at 7 days.

Social/Family Outing (Out on Pass/OOP) – a resident going out for a family event more than 4 hours (or overnight), or going out of the facility for under 4 hours. A nurse will perform a risk assessment on the resident when they return to the facility to determine if the resident needs to quarantine. As part of the risk assessment, a resident’s vaccination status will be considered. If the resident is not up to date with their vaccinations, a 5 -7 day quarantine on TBPs, will be necessary to ensure that they are not bringing Covid-19 into the facility which could place other residents and the facility at risk. The resident may be taken off TBPs if viral testing is negative at 7 days.

In addition, the facility will evaluate where the resident was and ultimately what the risk was of that resident contracting Covid-19 while being out of the facility. The Actors Fund Home understands that these “out trips” to the community are very important for socialization and mental health reasons but the facility has a responsibility to ensure that the resident that goes out does not bring Covid-19 back to the facility, and place other residents and staff at the facility at risk.

If it is decided that the resident should be on isolation, the resident will be given a Covid-19 PCR test on the date of returning and again on Day 7. As soon as the PCR test that is taken on Day 7 comes back as negative, isolation will be discontinued. Before quarantine ends, the resident will be given a final BD Veritor rapid test to ensure they remain Covid-19 negative. In the event at any time a resident develops symptoms or the facility is notified that during that out trip they had a direct exposure to someone with Covid-19, the quarantine will be extended to 10 days.

Other important factors that will be evaluated on the risk assessment is the duration of the out trip by the resident. If the resident is out for less than 4 hours there is less risk, while if they are out for greater than 4 hours, the risk is higher. In addition, we will also assess where they were, who they were with in terms of their vaccination status and of course the potential unknowns.

RETURN TO WORK PRACTICES AND WORK RESTRICTIONS FOR EMPLOYEES WITH CONFIRMED OR SUSPECTED COVID-19

Any employee with confirmed or suspected COVID-19 must be screened by a physician prior to returning to work and meet the criteria as outlined in the above documents.

Symptom-Based Strategy:

Facility staff who are not moderately to severely immunocompromised with mild to moderate illness should remain in isolation until 10 DAYS have passed since symptoms first appeared (for severe to critical illness, a minimum of 10 days, up to 20) OR 7 days with a negative viral test obtained within 48 hours prior to returning to work AND at least 24 hours have passed since the resolution of fever without the use of fever-reducing medication AND improvement in symptoms.
Time Based-Strategy:

Asymptomatic staff who are not moderately to severely immunocompromised should remain on isolation until 10 DAYS have passed since the date of first positive SARS-CoV-2 viral diagnostic test OR 7 DAYS with a negative viral test obtained within 48 hours prior to returning to work AND have remained asymptomatic (if symptoms appear during this time refer to above).
Test-Based Strategy:

Use of a test-based strategy and consultation with an infectious disease specialist or other expert and an occupational health specialist is recommended to determine when moderately to severely immunocompromised HCP may return to work. This approach may also be used for staff with severe to critical illness. Results from at least two consecutive specimens collected >24 hours apart using a viral test. When symptoms are present, there should be resolution of fever and improvement of symptoms as described above.

NOTIFYING RESIDENTS, STAFF AND FAMILIES WITH A CONFIRMED CASE OR A “PERSON UNDER INVESTIGATION” FOR COVID-19.

The facility shall notify all residents and staff members in person and in writing within 24 hours. The facility shall notify families or whoever is designated responsible for the resident via telephone, email or another form of communication within 24 hours, and must follow it up in writing within three days. This shall happen when a resident or staff member is a confirmed case or a “person under investigation” for coronavirus.

AFTER RETURNING TO WORK, EMPLOYEES SHALL:

Wear a facemask and eye protection at all times in all areas of the facility.
Be restricted form contact with severely immunocompromised residents (e.g. transplant, hematology-oncology) until 14 days after illness onset.
Adhere to hand hygiene, respiratory hygiene, and cough etiquette in CDC’s interim infection control guidelines (e.g., cover nose and mouth when coughing or sneezing, dispose of tissues in waste receptacles.)
Self-monitor for symptoms, and seek re-evaluation from their physician if respiratory symptoms recur or worsen.
Employees should be evaluated by a physician to determine appropriateness of earlier return to work than recommended above.

Employees with symptoms that may mimic coronavirus but are attributed to other diagnosis must obtain medical clearance in the form of a letter signed by a physician attesting that symptoms they may be experiencing (e.g., chronic cough) are due to other causes, and not due to an acute respiratory infection.

References:

https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html

https://www.cdc.gov/coronavirus/2019-ncov/hcp/long-term-care.html

https://www.nj.gov/health/cd/documents/topics/NCOV/Guidance_COVID_Diagnosed_andor_Exposed_HCP.pdf

https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html

https://www.cdc.gov/coronavirus/2019-ncov/hcp/long-term-care.html

https://www.nj.gov/health/cd/documents/topics/NCOV/Guidance_COVID_Diagnosed_andor_Exposed_HCP.pdf

https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html

https://www.nj.gov/health/cd/documents/topics/NCOV/COVID-19_Activity_Report_2022_09_08.pdf.