EPIC Newsletter
Emergency Preparedness Infection Control for Arizona's SNFs
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CMS Issues Rule on Staff Vaccinations
and Testing
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On May 31, 2023, CMS announced a final rule, “Medicare and Medicaid Programs; Policy and Regulatory Changes to the Omnibus COVID-19 Health Care Staff Vaccination Requirements; Additional Policy and Regulatory Changes to the Requirements for Long-Term Care (LTC) Facilities to Provide COVID-19 Vaccine Education and Offer Vaccinations to Residents, Clients, and Staff; Policy and Regulatory Changes to the Long Term Care Facility COVID-19 Testing Requirements.”
This rule will be effective 60 days after it is published in the federal register, which happened on June 5, 2023. So, expect this to be final on August 6, 2023.
This rule makes three key changes:
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Removes expired language addressing staff and resident COVID-19 testing requirements issued in the interim final rule (IFR) “LTC Facility Testing” on September 2, 2020.
CMS will not be enforcing the staff vaccination provisions between now and the effective date of this final rule. Please contact regulatory@ahca.org with questions.
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Infection Preventionist Call
The EPIC Infection Preventionist call is scheduled for Thursday, June 22 at 1:00.
Please email Kay Huff with any questions or to receive the Zoom link for the monthly calls.
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Utilize COVID-19 Tools
Over 3 years after the onset of the COVID-19 pandemic, May 11, 2023, marked the end of the federal COVID-19 Public Health Emergency (PHE) declaration. So, what does this mean for you? Most tools, like vaccines, treatments, and testing will remain available. But some tools, like certain data sources and reporting, will change. Here are a few key points to keep in mind:
- Vaccines will remain available. The U.S. government is currently distributing the COVID-19 vaccine for free.
- COVID-19 at home tests may not be covered by insurance, providers are no longer required to waive costs or provide free tests.
- Medication to prevent severe COVID-19 cases, such as Paxlovid will remain available for free while supplies last.
- National reporting of COVID-19 may change.
- COVID-19 case, and death data are no longer highlighted on the COVID-19 data tracker.
This pandemic has changed us all, especially those working in health care! While the PHE has come to an end, we must all stay vigilant and continue to prevent the spread of COVID-19.
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HSAG Releases Guides on NHSN, UTI and Pneumonia
Check out these new resources! First up is the NHSN Survival Guide for long term care facilities (click here). Next is their UTI Bundle which includes tools and posters. Last, they have the Pneumonia Bundle, which covers IPC processes as well as educational resources.
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AHCA WORKS Now Funds SNF Medication Assistant Training
We are excited to announce the AHCA WORKS grant now provides funding for Medication Assistant training in skilled nursing facilities. This funding will include payment for the training and lab supplies to support the course work. This training is an important career ladder for CNAs and will offer facilities new opportunities to develop their workforce. All Medication Assistant programs must be approved by the Arizona State Board of Nursing and candidates must be a CNA for 6 months to participate in the program.
In order to receive this funding for Medication Assistants, facilities must be an employer partner in the AHCA WORKS program. If you are interested in learning more about AHCA WORKS or the new funding for Medication Assistant training, please contact Jeffreys Barrett, Director of Workforce Development at jbarrett@azhca.org or 602-241-4649.
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Strategies to Prevent Multidrug Resistant Organism Transmission in Long Term Care
Long term care residents are at an increased risk for both colonization and infection by multidrug resistant organisms (MDROs.) The prevalence of S. aureus and IP colonization among residents has been estimated at higher than 50 percent, with new colonization acquisitions occurring frequently.
Because standard precautions have not been effective at controlling the spread of organisms and because contact precautions are less frequently adopted in SNF settings, infection preventionists (IPs) in these settings often seek additional strategies to help stop the spread. Two such strategies are enhanced barrier precautions (EBPs) and decolonization.
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ADHS Now Testing Door Force During Life Safety Surveys
ADHS SNF life safety surveyors are now using a meter to verify the amount of force it takes to open certain doors in a skilled nursing facility. Specifically, a Mechanical Force Gauge is being used to verify that it will take no more than 15 lbf (pound-force) of horizontal force to disengage a delayed egress locking device or release panic hardware. Here is an excerpt from the requirements cited in NFPA 101, The Life Safety Code (2012 ed.) as enforced by CMS and its contractors (ADHS):
7.2.1.6.1 Delayed-Egress Locking Systems.
7.2.1.6.1.1 Approved, listed, delayed-egress locking systems shall be permitted to be installed on door assemblies serving low and ordinary hazard contents in buildings protected throughout by an approved, supervised automatic fire detection system in accordance with Section 9.6 or an approved, supervised automatic sprinkler system in accordance with Section 9.7, and where permitted in Chapters 11 through 43, provided that all of the following criteria are met:
(3) * An irreversible process shall release the lock in the direction of egress within 15 seconds, or 30 seconds where approved by the authority having jurisdiction, upon application of a force to the release device required in 7.2.1.5.10 under all of the following conditions:
(a) The force shall not be required to exceed 15 lbf (67 N).
Similar requirements are cited in 7.2.1.7.1 for panic hardware. Here is the specific language citing the release of panic hardware:
(3) It shall be constructed so that a horizontal force not to exceed 15 lbf (66 N) actuates the cross bar or push pad and latches.
Since ADHS life safety surveyors will be verifying the horizontal force it takes to either release delayed egress locks or release panic hardware, providers should consider obtaining their own meters to help ensure proper operation of the doors as well as ensure compliance. Simply do a search for Mechanical Force Gauge to find these products from reputable suppliers.
Contact Stan Szpytek, AHCA Life Safety / Disaster Planning Consultant with any questions at Stan@azhca.org.
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CMS Updates SNF Survey Resources
CMS updated several documents in the Survey Resources folder including the Entrance Conference form and the Infection Prevention, Control, and Immunization Critical Element (CE) pathway. This was done to align with updated regulations and guidance related at the end of the public health emergency, and the expiration of
Changes to the Entrance Conference Worksheet include:
1. The removal of the following items:
- A list of residents who are confirmed or are suspected cases of COVID-19.
- Name of facility staff responsible for overseeing the COVID-19 vaccination effort.
- The facility’s mechanism(s) to inform residents, their representatives, and families of confirmed or suspected COVID-19.
- Documentation related to COVID-19 testing.
- List of residents and their COVID-19 vaccination status.
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The staff responsible for notifying all residents, representatives, and families of confirmed or suspected COVID-19 cases in the facility. This is consistent with QSO-23-13-ALL where CMS stated they will use enforcement discretion and not expecting providers to meet the requirement at F885.
2. The facility now must provide surveyors with the Medical Director’s phone number within one hour of entrance.
Changes to the Infection Prevention, Control, and Immunization CE pathway include:
- Requirements to review employee COVID-19 vaccination information was significantly reduced.
- Requirements to review source control were changed to only require surveyors to ensure source control is in accordance with national standards.
- Surveyors are only required to ensure COVID-19 testing is in accordance with national standards.
- Surveyors must ensure facility residents and staff were offered and educated on any potential risks of receiving the COVID-19 vaccination.
Surveyors must ensure visitors were educated of the potential risk, before visiting residents on Transmission Based Precautions. Contact AHCA’s Kay Huff with further questions.
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Be Prepared for Seasonal Heat-Related Emergencies
Don't wait for temperature records to be shattered or the power to fail at your LTC facility this summer before preparing your team for heat-related emergencies.
Now is the time to prepare for the hazards and perils associated with extreme heat emergencies. Train your staff to understand that high temperatures not only represent the obvious threats associated with heat-related illness. Excessive heat can also cause a variety of problems including region-wide power failure and internal mechanical / equipment failure in prolonged incidents as well as staffing issues and supply chain disruption.
In addition to reviewing the guidance contained in your facility's Emergency Operations Plan (EOP), visit the Disaster Ready Website, linked below, and go to the "Prepare" page for additional information and resources.
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Life Safety Alert: Door Alarms and Delayed Egress Locks
Skilled nursing facilities, assisted living communities and memory care units are equipped with sophisticated safety systems including door alarms, wander management solutions and delayed egress locks to help safeguard residents. These systems are designed to keep residents safe and secure under normal conditions as well as provide them with an unimpeded path out of the building when an emergency evacuation is required.
When a fire alarm system activates or a power failure occurs, some of these systems will disengage to allow safe egress during an emergency. Of course, conducting fire drills or unscheduled power failures can also disengage some of these systems. It is essential to train your staff to understand the security and elopement risks that exist when these systems are disengaged either during a real-world emergency or drill. Appropriate measures need to be in place to reset or re-arm these critical systems as quickly and efficiently as possible to reduce the risk of elopement or unauthorized entry into a facility.
Contact Stan Szpytek, AHCA Life Safety / Disaster Planning Consultant with any questions at Stan@azhca.org or call him at (708) 707-6363.
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AHCA Convention and Expo, July 25-27 | 15 CEUs
Register TODAY!
The 2023 AHCA Convention and Expo: Quality… Seeing the Forest AND the Trees registration is now open! Check out our stellar speaker lineup in the convention program book. You won’t want to miss this year’s event.
Don’t miss out on our Wednesday evening events!
Dementia Moments: Hands-on Dementia Training: This workshop provides an interactive experience during which the participants perform some daily living tasks as if they are living with Alzheimer’s disease or another dementia.
Murder Mystery “The Riddle” Team Building Event: The Riddle first reached popularity in New York in 1989 when comedy writer/director Phil Valentine and mystery writer Charles Anthony Mount created the funniest and most unique murder mystery ever! This is an audience participation comedy event! Bring your teams for an evening of team building fun. Thank you to Maricopa Ambulance for sponsoring this event!
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EPIC IPC Support Available to SNF and AL for FREE
The Emergency Preparedness and Infection Control (EPIC) grant administered by AHCA continues to offer onsite technical assistance in infection prevention and control. Dr. Buffy Lloyd-Krejci and her team at IPCWell are contracted to provide this support to skilled nursing facilities and assisted living communities statewide in our 2022/23 grant. In fact, they’ve put together this short video explaining what they look for during an IPC visit: Click here.
Overall, they may assist with strengthening best practices, auditing IP protocols, reviewing policies, reporting, and addressing IP issues identified in the survey process.
The EPIC program will provide a one-time onsite visit, FREE of charge. If you would like to be on a list to receive this technical assistance, please contact Dr. Buffy directly at buffy@ipcwell.com.
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Check out our DR EPIC Helpline!
To submit questions, email the DR EPIC online helpline at EPIC@azhca.org. You can also call the DR EPIC phone Helpline at 602-241-4644 and we will assist you. or valuable infection prevention resources! Go to: EPIC.DisasterReadyaz.org to explore these tools.
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Questions? Contact EPIC@azhca.org |This program is funded by ADHS
The Disaster Ready Emergency Preparedness Infection Control (DR EPIC) program provides education and technical assistance for skilled nursing providers throughout the state. Individual providers will need to exercise their independent discretion in how to apply this information and technical assistance to the unique operation of each facility. For that reason, a facility’s of its professional judgment and due diligence in utilizing the program for infection control and risk management practices is solely within the facility’s control for which it is entirely responsible.
Copyright 2023.
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