Roadmap: Key Strategies for
Preventing COVID-19 in Nursing Homes
What strategies should our facility use to prevent the spread of COVID-19?
All of the following strategies should be used:
- #1 Universal Staff Screening
Actively monitor all staff daily for fever and symptoms of COVID-19. If any staff screens positive for any fever or symptoms, they should be tested for COVID-19 and sent home to recover. See “When You Have COVID-19 Cases in Your Nursing Home.” Upon entry, obtain staff temperature using a touchless thermometer. In addition, inquire about any of the following:
The Orange County Nursing Home Infection Prevention Team is coordinated by the University of California, Irvine Health and is jointly funded by Orange County Health Care Agency and CalOptima Last Updated: 5/26/20
- #2 Universal Resident Screening
Actively monitor all residents daily for fever and symptoms of COVID-19, as above. If any of these symptoms are found, the resident should be isolated from other residents and a physician should assess the resident for additional medical care needs. See “When You Have COVID-19 Cases in Your Nursing Home”.
Staff should all wear a mask covering the nose and mouth whenever on nursing home premises unless they are eating while on break. Follow facility protocol for mask use. Staff that do not have direct contact with residents (e.g. front desk, administration, housekeeping) can wear a community cloth mask. All direct care healthcare workers should wear a disposable standard mask provided by the facility during resident care activities.
Residents who can tolerate a mask should wear a standard or cloth mask whenever in common areas and when staff are within 6 feet of the resident.
All residents should be kept at least 6 feet apart from one another. All staff should try to keep 6 feet apart from other staff members whenever possible. When staff must interact within 6 feet of residents, the staff member should be masked and mask the resident if the resident will tolerate a mask. In addition, staff who work in nursing homes should be careful about social distancing and avoiding ill persons outside of work because of the risk of bringing infection into the nursing home.
- #5 COVID-19 Surveillance Testing
CMS requires nursing homes to test all staff members weekly and to test residents at least once and then as needed based upon symptoms or exposures. Testing staff members helps ensure a repeat frequency of COVID-19 status checks that are important in facilities that care for high risk individuals. Orange County Health Care Agency is working with nursing homes to help establish weekly testing.
https://www.cms.gov/files/document/covid-nursing-home-reopening-recommendation-faqs.pdf
- #6 Personal Protective Equipment
Personal protective equipment will help prevent exposures to residents who are diagnosed with COVID-19 or have symptoms that may be compatible with COVID-19.
- When caring for a resident with suspected or confirmed COVID-19, you should wear a surgical/standard facemask in addition to having the resident masked, if tolerable. This “Two-Way Droplet” masking provides additional protection from potential exposure.
- If the resident cannot wear a mask or is non-compliant, you must wear eye protection (face shield or goggles) in addition to the facemask (“Droplet-Eye protection”).
- If an aerosol generating procedure is performed (e.g. CPR, open suctioning, nebulizer therapy, positive pressure ventilation such as CPAP), wear an N95 respirator instead of a standard droplet mask while performing the procedure.
- Gowns and gloves should be worn for each care activity for a confirmed or suspect COVID+ patient, if they are available. Gowns should be laundered or thrown away (if disposable) after each use.
- For additional directions, protocols, and examples, please see other documents in this toolkit at ucihealth.org/stopcovid
One of the ways to catch COVID-19 is to touch infected droplets and then touch your eyes, nose, or mouth.
- Ensure staff clean their hands with alcohol hand rub or soap and water each and every time before they touch their face or adjust their mask
- Clean hands before and after touching a resident or their environment https://www.who.int/infection-prevention/campaigns/clean-hands/5moments/en/
- Help residents clean their hands often, including before eating and before/after toileting
- #8 Environmental Cleaning
The virus that causes COVID-19 commonly survives on surfaces for several hours, and has been shown to survive on surfaces for up to 1-2 days. Thus, it is important to ensure that high quality environmental cleaning is occurring
- Follow your facility guidelines for resident room cleaning and cleaning of common areas. Cleaning resident rooms helps ensure that residents with COVID-19 do not spread the virus to staff or other residents. Cleaning of common areas and break rooms is equally important to prevent staff from spreading COVID-19 virus to one another either due to contaminated surfaces, contaminated hands, or from staff who work while ill.
- See cleaning protocols at ucihealth.org/stopcovid
All the above activities require monitoring systems to ensure that these processes are occurring correctly and consistently in the nursing home. Monitoring forms should be created and observers should be assigned to check on processes regularly (we recommend at least weekly if not more often). Example monitoring forms for hand hygiene, proper mask wearing, proper donning and doffing of personal protective equipment, and environmental cleaning are found at ucihealth.org/stopcovid
- #10 Encouraging Speaking Up
Safety is a partnership among all staff in a nursing home. Ensuring the safety of staff and residents in the nursing home requires working together. Place signs up to remind staff about key prevention activities. Encourage staff to speak up at critical times, such as:
- When feeling ill or hearing someone else feels ill
- When seeing someone eat without cleaning their hands
- When seeing someone touch their mask or face without cleaning their hands
- When seeing an error in donning or doffing PPE
- When noticing a surface is contaminated
- When needing help
Give special attention to nursing home break rooms
The safety of residents depends on the safety of staff members. One important area that requires special attention is the staff break room, where staff go to rest or eat. Because this is an area where staff may remove their mask to eat and sit in close proximity to one another, additional safeguards are necessary:
- If the break room is small, other space needs to be designated for staff to eat
- Ensure chairs are separated by 6 feet, and alcohol hand rub is available
- Ensure signage to:
- Remind staff to socially distance, clean their hands before eating, store their mask properly before eating, ensure food is placed on a clean surface
- Ensure area is cleaned often, and that disinfectant wipes are available
Where can I go to learn more?
- Refer to the OC Nursing Home COVID-19 Infection Prevention Toolkit for more information and additional FAQs at ucihealth.org/stopcovid
- Up to date information on 2019 Novel Coronavirus can be found at:
The Orange County Nursing Home Infection Prevention Team is coordinated by the University of California, Irvine Health and is jointly funded by Orange County Health Care Agency and CalOptima Last Updated: 5/26/20