Thursday, October 14, 2021
EPIC Newsletter
For Arizona SNFs - Emergency Preparedness Infection Control
Mark your Calendar for the IP Call

Each month EPIC hosts a 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 on Thursday, October 28th at 1:00 pm.
Infection Prevention, Control & Immunizations Critical Element Pathway used in Surveys
Infection Prevention, Control & Immunizations Critical Element Pathway is used by surveyors to investigate a facility’s compliance with F880, F881, F882, F883, F885, F886, and F887 and is the same tool used for COVID-19 Focused Infection Control Surveys. This CE pathway is also a great tool for facilities to assess their compliance with the infection prevention and control program (IPCP) requirements. It describes how components of the IPCP will be evaluated for compliance and provides links to the CDC to obtain information about current guidance. Facilities are expected to be in compliance with CMS requirements and surveyors will use guidance that is in effect at the time of the survey. Find up-to-date CMS QSO memos here.

It’s that time of year again when facilities are required to offer residents the annual influenza vaccine unless medically contraindicated or they have already been immunized for the current season.

CMS requires facilities to offer the influenza vaccine from October 1 through March 31 annually; however, the CDC recommends offering the vaccine when it becomes available each season which also meets the CMS requirement. This requirement also includes that each resident is offered a pneumococcal immunization, unless the immunization is medically contraindicated, or the resident has already been immunized.

Prior to offering influenza and/or the pneumococcal vaccines CMS requires facilities to develop policies and procedures to ensure that each resident or the resident’s representative receive education regarding the benefits and potential side effects of the influenza and pneumococcal immunizations prior to them being offered and the resident’s medical record includes documentation of this. The documentation should also include whether the resident received the immunization, or not due to medical contraindication or refusal. The guidance to surveyors includes “review facility policies regarding the provision of vaccines in order to determine if the policies reflect current standards of practice.”

For information related to current vaccine recommendations including scheduling and contraindications, refer to Frequently Asked Influenza (Flu) Questions: 2021-2022 Season | CDC or https://www.cdc.gov/vaccines/pubs/pinkbook/chapters.html.
Medicare.gov Features Vaccination Data

CMS is making it easier to view COVID-19 vaccination rates for nursing home residents and staff with a new feature on their website medicare.gov. “CMS knows that nursing home staff want to protect their residents and is calling on them to get vaccinated now. The COVID-19 vaccine is safe, effective and accessible to all at no out-of-pocket cost.” said CMS Administrator Chiquita Brooks-LaSure. Medicare and Medicaid-certified nursing homes have been required to report weekly COVID-19 vaccination data for both residents and staff since May and has been posting the information on the CMS COVID-19 Nursing Home Data website. This is a valuable tool for families, residents and patients to understand the quality of nursing homes when making decisions related to health care. 
New Federal Funding for Infection Prevention Announced

The Biden-Harris administration recently announced a $2.1 billion investment to enhance infection prevention and control (IPC) activities across the United States public health and healthcare sectors. With this funding, state, local, and territorial public health departments, and other partner organizations will be better equipped to fight infections in our healthcare facilities, including COVID-19 and other known infectious diseases. “Funding will provide significant resources to our public health departments and healthcare systems and opportunities to develop innovative strategies to protect every segment of the U.S. population, especially those disproportionately affected by the pandemic, at a time that they are hit hard.” said CDC Director Rochelle P. Walensky, M.D., M.P.H. To learn more go to:
Respirators…Know the Basics
A NIOSH-approved N95 is the most common type of filtering facepiece respirator (FFR), which is a type of disposable respirator meant to form a tight seal to the face, removing particles from the air as you breathe through it. This includes all types of particles, such as bacteria, viruses, and dust.

N95s are heavily regulated and enforced:
Respirators used in occupational settings, including N95s, are meant to be part of a workplace’s respiratory protection program. These programs are regulated by the Occupational Safety and Health Administration (OSHA) (29 CFR 1910.134) and must include specific elements such as a respiratory protection program, medical evaluation, annual fit testing and training. The National Institute for Occupational Safety and Health (NIOSH) is the federal agency responsible for testing and approving respirators used in U.S. workplace settings. As part of these tests, NIOSH uses a near worst-case penetrating aerosol size of 0.3 µm (i.e., particles that are best able to make it through a filter). An N95 respirator must not allow more than 5% of these particles to penetrate through. This ensures that every respirator that passes these tests will filter potentially hazardous particles as expected when used in real-world situations. If your respirator has been approved by NIOSH, you can be confident that it is working as expected to protect you as long as:
  • It is properly maintained (for disposable N95’s there is no maintenance)
  • It is worn and used correctly
  • It fits properly
  • It is replaced as recommended by the manufacturer

Beware of counterfeits:
Counterfeit respirators have not undergone NIOSH testing and evaluation, but were specifically manufactured to mimic a respirator product that did receive NIOSH approval. Because these products are not NIOSH approved, they may not be capable of providing appropriate respiratory protection to workers. Examples of known counterfeits can be seen at Counterfeit Respirators / Misrepresentation of NIOSH-Approval | NPPTL | NIOSH | CDC or https://www.cdc.gov/niosh/npptl/usernotices/counterfeitResp.html. For more information contact EPIC consultant Derrick A. Denis at DerrickDenis@csceng.com. 
Learn More about Candida auris
CMS reports that some health care facilities have reported that a type of yeast called Candida auris (also known as C. auris) has been causing severe illness in hospitalized patients. In some patients, this yeast can enter the bloodstream and spread throughout the body, causing serious invasive infections.

  • What is the treatability of C. auris?
“Most C. auris infections are treatable with a class of antifungal drugs called echinocandins. However, some C. auris infections have been resistant to all three main classes of antifungal medications, making them more difficult to treat. In this situation, multiple classes of antifungals at high doses may be required to treat the infection. Treatment decisions should be made in consultation with a healthcare provider experienced in treating patients with fungal infections.” For more information go to: General Information about Candida auris | Candida auris | Fungal Diseases | CDC 

  • What is the recommended surveillance?
“Candida auris is a nationally notifiable condition and is reportable in many states. Laboratories that identify cases of C. auris should report cases immediately to the state or local health department and to CDC at candiddaauris@cdc.gov.” To learn more check out this link: Surveillance for Candida auris | Candida auris | Fungal Diseases | CDC.
Two Common Issues with Fire Protection and Life Safety Documentation
 
As survey teams get back into skilled nursing facilities to assess compliance with NFPA 101, The Life Safety Code (2012 edition) and all other referenced codes and standards itemized in Chapter 2, there are two emerging documentation issues being identified. Some facilities are failing to record quarterly fire sprinkler system water flow times (activation of alarm within 90 seconds of water flow) and/or the transfer time (10 seconds or less) for the emergency generator system's monthly 30 minute load test. This information is simply not being recorded. Whether these tests are being performed by in-house personnel or by a vendor, it is imperative that these times are properly recorded in accordance with NFPA inspection, testing and maintenance (ITM) requirements. Contact Stan Szpytek, AHCA's Life Safety Consultant at Stan@azhca.org or (708) 707-6363 with any specific questions.
Mental Health and Wellness During a Pandemic

It is clear that long term care staff have encountered many mental challenges during the on-going pandemic. Some of these challenges include stress related to new infection control procedures, continuous use of PPE, supply delays, staffing shortages and the underlying emotional toll that COVID-19 has thrust upon this loyal but overwhelmed workforce. It is important to remind caregivers and support staff that they must care for themselves first to help ensure that they can adequately care for others. Promoting personal mental health and wellness during the current pandemic and future adverse events is essential. Here are links to two websites that your team may find beneficial from the U.S. Department of Veterans Affairs:
Infection Prevention Personnel and Emergency Planning
 
CMS has made it clear that infection prevention personnel should be part of a skilled nursing facility's emergency planning process. Memos issued by CMS over the course of the last year updating the Emergency Preparedness Rules of Participation (Appendix Z) address this matter. Emergency Operations Plans (EOP) are required to be developed in accordance with the identified threats and perils that can potentially impact a facility. Emerging Infectious Diseases (EID) and pandemic most certainly have been identified as a potential hazard by every facility. Therefore, personnel who specialize in this particular area of facility operations like an Infection Preventionist should be part of the emergency planning team. 

AHCA/NCAL has developed a summary document that clarifies this important point on page 2 (bullet 2)- here is a link to this resource.
COVID-19 Emergency Management Still Equates to CMS Exercise Equivalency into 2022

Skilled nursing facilities must ensure that they meet all of the Emergency Preparedness exercise requirements each survey cycle in accordance with E-039. This includes participation in a full-scale, community-based exercise as well as an additional exercise of choice like a tabletop exercise conducted annually during each survey cycle. The current COVID-19 Public Health Emergency (PHE) provides facilities with an equivalency to the full-scale, community-based exercise into 2022 as long as the facility is still managing the incident with its Emergency Operations Plan (EOP). This means that proper documentation must be developed to illustrate to surveyors that the SNF is still managing an active, real-world incident. A CMS memo dated September 28, 2020 and revised June 21, 2021 provides additional clarification and explains the exercise equivalency in detail. Contact Stan Szpytek, DR/EPIC Consultant at stan@azhca.org with any questions.
Question of the Week

Q: When can extended use of an N95 or well-fitting facemasks be considered as a conventional capacity strategy? 

A: According to CDC Infection Control on COVID-19: When N95s or well-fitting facemasks are used solely for source control they may be used for an entire shift unless they become soiled, damaged, or hard to breathe through.
 
When N95s or well-fitting facemasks are used during the care of a patient for which a NIOSH-approved respirator or facemask is indicated for personal protective equipment (PPE) (e.g., NIOSH-approved N95 or equivalent or higher-level respirator during the care of a patient with SARS-CoV-2 infection, or during care of a patient on droplet precautions), they should be removed and discarded after the patient care encounter and a new one should be donned.
Check out our DR EPIC Helpline!
To submit questions, email the DR EPIC online Help Center at EPIC@azhca.org. You can also call the DR EPIC phone Helpline at 602-241-4644 and we will assist you.

Don’t forget to utilize our DR EPIC website for 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 2021.