Coronavirus Update #196
New Orders from the Maryland Department of Health and Governor Hogan
During a press conference today, Governor Hogan announced new orders from the Maryland Department of Health.

Amended Orders from the Maryland Department of Health

MDH Order- Amended Nursing Home Matters (Weekly Testing and Visitation Limitations)
  • Staff testing:

  • Staff, volunteers, vendors shall be tested twice a week with a combination of one PCR & one POC (done on different days) until further notice.

  • NOTE: The State is mandating our sector test staff twice a week, one PCR and one POC; MDH strongly recommends that all nursing homes test all staff to the maximum degree possible based on POC system and supply availability. This includes testing twice a week using a POC system.

  • MDH will provide every nursing home with BinaxNow POC to maintain 2x a week testing for all STAFF (Becton Dickinson for those that use that platform currently).

  • NOTE: The State will begin distributing POC testing supplies next week. The State has committed to providing testing supplies for POC machines through the end of 2020.  

  • Resident Testing:

  • Mandatory weekly testing of residents with PCR.
  • Visitation:

  • No change in outdoor visitation.

  • All visitors must have a negative COVID-19 test prior to their visit. They must have been tested within 72 hours of their visit. If the facility is currently in outbreak status, then indoor visitation shall be suspended except for cases of compassionate care. Each facility may determine on an individual basis requests for compassionate care visitation.

  • If a local jurisdiction is below 5% positivity, nursing homes shall continue to implement CMS guidance on visitation.  

  • If the local jurisdiction is within 5-10% positivity, each nursing home shall restrict the number of indoor visitors to no more than 5% of the total residents at the facility at any one time.

  • If the local jurisdiction is greater than 10% positivity or if the facility is in a current outbreak situation, indoor visitation shall be prohibited.

MDH Order- Amended Various Health Care Matters (Hospital Surge 2, At Home Testing, Hospital Visitation)
  • At-home testing:

  • Expressly permits and FDA-approved test that uses at-home or self-collection.

  • Elective/non-urgent procedures:

  • Adds requirement that hospitals have sufficient capacity for COVID/non-COVID patients before resuming elective/non-urgent procedures and must utilize a prioritization algorithm on how they will curtail or suspend elective/ non-urgent procedures when they do not have enough capacity.

  • Hospital surge plan:

  • Hospitals shall try to get informed consent before transferring a patient to an alternate care site (ACS) or other healthcare facility.

  • COVID-19 Positive ED patients and COVID-19 Positive inpatients may be transferred to a COVID-19 ACS or other treatment location that meets their clinical needs may be transferred when the hospital they presented to is unable to admit them.

  • COVID negative inpatients or ED patients may be transferred to another healthcare facility that meets their clinical needs.

  • All reasonable efforts shall be made to transfer to a location closest to the originating facility and to notify the patient’s authorized decision maker or identified family.

  • End date for all transfer provisions is 1/31/2020 unless renewed.

  • Hospital Visitation:

  • Except for compassionate care, parents of minor patients, obstetrics, and support person for individual with disabilities, all hospital visitation is prohibited until further notice.

  • Hospitals shall limit visitation to visitors who are essential to the patient’s physical or emotional wellbeing and comply with the CDC guidance.

  • Nursing Home and Hospital Mutual Aid in Nursing Home Outbreak Situations

  • When an outbreak occurs in a nursing home, a nursing home shall coordinate with hospital(s) located in the nursing home’s corresponding MIEMSS region to ensure adequate staffing support from the hospital, including direct clinical care, and infection control technical assistance where appropriate to ensure adequate continued care and infection control; such support may include the provision of a certified infection control (CIC) professional to the nursing home. When contacted, a hospital shall render all assistance possible.

  • All nursing homes shall establish at least one mutual aid arrangement with another nursing home facility to ensure continuity of operations, to include ensuring adequate staffing support.

Updated Guidance from the Maryland Department of Health

  • Encourages “off-label use” of the test for screening purposes (i.e. 2x/week or for asymptomatic persons in a congregate setting with an active outbreak).

  • Clarifies when a confirmatory PCR test should be performed.

  • Low probability of infection + positive POC = confirmatory PCR recommended.

  • High probability of infection + negative POC = confirmatory PCR recommended.

  • Provides clarity and simplification of current guidance.

  • All facilities utilizing POC testing must follow federal CDC and FDA guidance.

  • Provides guidance and suggestions for any organization setting up indoor COVID-19 testing.

  • Focused recommendations and best practices regarding. 

  • Space and square footage.

  • Client flow and location accessibility.

  • Cleaning surfaces and personal hygiene.

  • Ventilation.
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Thank you.

We cannot thank you enough for the dedication and diligence in doing all that you can for the residents in your communities. HFAM continues to monitor the COVID-19 pandemic with our state and national partners and will do all we can to support you during this time.