Friday, March 15, 2022
EPIC Newsletter
For Arizona SNFs - Emergency Preparedness Infection Control
Check Out Dr. Buffy’s New Book – Available Today!
Many of you know and have worked with Dr. Buffy Lloyd-Krejci. Well, now she has a new book called BROKEN: How the Global Pandemic Uncovered a Nursing Home System in Need of Repair and the Heroic Staff Fighting for Change that is out today!

In short, the book describes a health care system that has been operating far below infection prevention and control best practices long before the pandemic and that NOW is the time to support this healthcare system, instead of the constant battering being received.
Infection Control Tabletop Exercise Planned for Phoenix

When: Thursday May 10, 2022 | 10am-2pm
Where: Health Services Advisory Group
3133 East Camelback Rd. | Phoenix, AZ 85016
Lunch provided
 
This unique tabletop exercise will focus on infection control protocols. It will be facilitated by the DR / EPIC Team who will present participants, also known as "players," with a simulated scenario that involves some type of condition within the built-environment of a SNF that is having an adverse effect on residents. This exercise requires a "team approach" that utilizes all disciplines within a nursing facility. Therefore, attendees should include administrators, clinical staff, maintenance, housekeeping, dietary and others that may be responsible for emergency management. It is recommended that multiple team members from your facility register for this interactive exercise.
Antibiotic Stewardship Training to be held in May in Flagstaff

EPIC Consultant, Dr. Peter Patterson, will present a morning seminar on antibiotic stewardship. This topic is especially important in infection prevention and control. It will be held on May 25th at the Twin Arrows Casino Hotel in Flagstaff.
2022 AzCHER Community-Wide Exercise and After Action Conference Scheduled
 
The AzCHER Community-Wide Exercise will take place on April 21 from 9:00 am - 1:00 pm. Participation in this exercise process including the After Action Conference will help CMS-regulated health care facilities comply with the requirements of E-039. Information for the exercise will be sent out to participating facilities at 8:30 am. Over two-hundred health care providers are registered for this exercise. Several different types of health care providers including SNFs will be participating in this statewide exercise. Each participating facility will need to identify a Controller and an Evaluator. The Controller will drive play during the exercise and the Evaluator will capture "real time' actions of the facility as it relates to the exercise and the facility's objectives. The Controller's and Evaluator's comments will be used to develop the After-Action Report (AAR) which will consist of the following:
 
  •  A summary of key information related to the exercise evaluation
  •  Focus on the overall analysis of healthcare capabilities
  •  Identification of strengths and areas in need of improvement
  •  Individual facilities will use the information to create an Improvement Plan (IP) to address areas of improvement
 
AzCHER will also conduct an all-participant After-Action Conference on May 26th from 9:00am – 12:00 pm to obtain input from participating organizations to help develop the AzCHER Improvement Plan. If you have any questions about the Community-wide Exercise or After Action Conference, please contact Gil Damiani at Gild@azhca.org or call him at 480-682-7760.
DR EPIC Infection Control Training (FREE)

The Disaster Ready Emergency Preparedness Infection Control (EPIC) program is offering two FREE infection control training courses.

  • The Infection Preventionist Specialized Training (IPCO) is a specialized course of study for healthcare professionals who desire to serve as Infection Preventionists (IPs) this program. Individuals taking this course will be specially trained to effectively implement and manage an Infection Prevention and Control Program in a nursing center.
  • The Infection Prevention & Control in the Post-COVID-19 World provides a review the basics of infection prevention and control practices and will look at the future of infection prevention and control. This course also describes the process for cohorting practices and will look at how to conduct self-assessment processes to continually evaluate and improve the infection prevention and control program in long term care. 

For more detailed information on these trainings click here or contact Kay Huff at Khuff@azhca.org.

These two courses can either be taken by one person or you can separate them out and allow two individuals from one facility to each take one training. If you are interested in taking one or both trainings, click on the links below to complete the interest forms. Once we have your contact information from the forms, you will receive an email from us (AHCA) with further instructions on how to register. There will be no fees associated with these two trainings because they are grant funded.
Understanding COVID-19 Testing and Community Transmission Level

To meet one of the requirements at F886 COVID-19 Testing facilities must routinely test staff who are not up to date with their COVID-19 vaccination based on the COVID-19 Community Level. See the graphic below. 
To determine what the current COVID-19 Community Transmission Level is for testing CMS provides instruction at Finding Community Transmission Levels. These instruction direct the user to first select the state and the county then to scroll down to the map, use the drop down for data type and select Community Transmission. Facilities should not use the COVID-19 Community Level section directly above the map to determine the frequency of routine staff testing. As this data differs greatly from the COVID-19 Community Transmission Level. 

As Arizona’s Level of Community Transmission changes from higher to lower levels facilities are reminded to follow guidance in CMS QSO-20-38-NH Revised. The guidance includes that facilities should be routinely testing all staff who are not up-to-date with their COVID-19 Vaccine. Routine testing should be based on the level of community transmission. If the level of community transmission decreases to a lower level of activity, the facility should continue testing these staff members at the higher frequency level unit the Community Transmission level remains at the lower activity level for at least two. After two weeks facilities can begin testing staff at the lower frequency. This guidance also includes that if the level of community transmission increases to a higher level of activity, facilities should begin testing to the higher frequencies as soon as the criteria for higher activity level is met. More tools than ever before are available to prevent COVID-19 from placing strain on communities and health care systems.
State of the Union Addresses Nursing Homes

On Tuesday March 1st, President Biden announced nursing home reforms during the State of the Union address. The nursing home agenda – “Protecting Seniors and People with Disabilities by Improving Safety and Quality of Care in the Nation’s Nursing Homes” included a Fact Sheet issued by the White House on February 28th. Some key elements in this agenda include:

  • “Every nursing home provides a sufficient number of staff who are adequately trained to provide high-quality care”
  • “Poorly performing nursing homes are held accountable for improper and unsafe care and immediately improve their services or are cut from taxpayer dollars” and
  • “The public has better information about nursing home conditions so that they can find the best available options.”

It is important to note that national AHCA/NCAL is working diligently to advocate on behalf of nursing homes on Capitol Hill They are focusing their efforts to educate members of Congress about the challenges nursing homes face and the focus on quality that has been our priority in the last decade. Long term care representatives from Arizona will join other states in DC at the National Congressional Briefing.
Governor Ducey Terminates the State’s COVID-19 Public Health Emergency
 
The Arizona COVID-19 Public Health Emergency was terminated last week by Governor Ducey which took effect immediately. It’s important to note that the federal Public Health Emergency (PHE) was recently extended through July 16, 2022. The federal PHE is the one that governs SNF waivers and the TNA program. Until that one is removed, all waivers and programs will continue.
FDA Approves Second Booster for COVID-19
 
A second COVID-19 booster was approved by the U.S. FDA on March 29. Both Pfizer-BioNTech and Moderna booster vaccines have been approved for adults 50+. The fourth shot (second booster) was also authorized for immunocompromised children older than 12 when receiving the Pfizer-BioNTech vaccine and the Moderna was authorized for immunocompromised adults over 18 years old. It is unknown at this point if the boosters will be mandated for long term care.
Wildfire Season Awareness   
 
The overall lack of precipitation in Arizona this past winter should prompt long term care providers of all types to be acutely aware of the inevitable wildfire threat. As attendees of the 2022 Disaster Ready Summit learned during a special presentation by two providers from Colorado who experienced a fast-moving vegetation fire near Boulder in late 2021, these adverse events can occur during non-traditional times. It's time to open up your EOP and review your wildfire plans with your team. Whether you will be required to shelter-in-place or evacuate, your facility must be ready for wildfires and other adverse events that can occur with little or no warning. It is essential to ensure that your team is "Disaster Ready" all day and every day.
Laundry Room Fires Can be Prevented (Especially During a Pandemic)

As providers implement extensive measures to keep linens and other materials clean and sanitized during extraordinary times like a pandemic, laundry rooms and particularly the commercial clothes dryers in a health care facility get quite a workout. It is likely that the number of loads and overall activity within this area of environmental services has increased during the current public health emergency. With this in mind, it is important for facilities to understand the ever-present threat of a fire in the laundry room and do everything possible to prevent this type of incident. Through the development of good policies and procedures, preventative maintenance regimens and proper use of laundry equipment, the risk of fire can be almost completely eliminated. Here is an article by Stan Szpytek, AHCA Life Safety / Disaster Planning Consultant recently published in McKnights LTC News that discusses ways to help ensure safety and eliminate a fire in your facility's laundry department. 
Join the Infection Preventionist Call

Each month EPIC hosts a Zoom call targeted to infection preventionists in skilled nursing facilities. If you are interested in participating please send your contact information to Kay Huff and we will send you a link to the call. The call will be held Thursday, April 28th at 1:00 pm.
Fit Test Failures and N99 and N100 Respirators- Q & A 

Question: “A facility contacted me and said they were on a “webinar” and they were told that if a person “fails” a N95 fit test they must be given and tested with an N99 or N100? Was this directive given during the webinar accurate?”

Answer: No. This is not a requirement Federally or in the state of Arizona. N99 or N100 filtering facepiece respirators (FFRs) do offer better filtration of 0.3 micron particles (the most difficult particle size to capture) over N95s, but they do not offer specifically offer better fitment.  Failure of an N95 fit test is generally not based on failure of the filter media, but instead is almost invariably a failure of the facepiece-to-skin seal. Individuals have uniquely shaped noses, chins, cheeks, ears, skulls and hair and this can often make fitting a respirator difficult, or in some cases, impossible.
 Here are some viable options for employees who do not pass an N95 fit test include:
  • Assign that individual to a role that does not require respiratory protection.

  • Try again at a later date if the failure was based on a lack of taste. (e.g. if they had COVID-19, wait for their taste to return).Until they pass a fit test, they should not wear a respirator.

  • Obtain alternate N95 makes, models or sizes, and fit test them on those units. 
  1. Remember passing a fit test on an N95 does not mean the employee can wear any N95. Employees must pass a fit test on each specific make model and size respirator the employee intends to wear.
  2. Keep in mind, if alternate N95 respirators are selected, then you might create supply chain hurdles for your facility. 

  • Obtain alternate respirator types (1/2 face APR, full face APR, tight fitting PAPR, loose fitting PAPR, Supplied air (line, SCBA, etc.). 
  1. Air purifying respirators (APRs) and powered air purifying respirators (PAPRs) would usually be equipped with P100 (HEPA) filters for COVID-19 related work. 
  2. These respirators all have exhalation valves, and therefore would not be suitable for protecting uninfected individuals from any airborne transmitted pathogens carried by the wearer.  
  3. Loose-fitting PAPRs do not require fit testing, but they leak outward as well. 
  4. Cost for advanced reusable respirators, like APRs and PAPRs, can be significant (e.g. under $50.00 to over $2,500). These devices will require purchase of filter cartilages separately. Supplied air units are usually even more expensive. Device-specific annual training, maintenance and inclusion of these devices in the written respiratory protection program (RPP) are also required.
  5. Keep in mind, if alternate respirators (advanced respirator) are selected, then you might create supply chain hurdles for your facility.
 
Remember, annual fit testing, annual respirator training, a medical eligibility release and a written respiratory protection program (RPP) are all federal requirements outlined in 29CFR 191.134 for any N95, N99, N100 or any other respirator.
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.
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 2022.