Wednesday, February 16, 2022 |
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EPIC Newsletter
For Arizona SNFs - Emergency Preparedness Infection Control
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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 Helplineine 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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Mark Your Calendars for Upcoming EPIC Events
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Wednesday, March 23 - Annual Disaster Ready Summit | Phoenix | Register Here
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Thursday, May 10 - EPIC Infection Control Emergency Preparedness Tabletop Exercise| Phoenix| Register Here
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Wednesday, May 25 - EPIC Training: Antibiotic Stewardship Training | Flagstaff
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Thursday, June 9 - EPIC Antibiotic Stewardship Training | Tucson
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Wednesday, June 22 - EPIC Infection Control Emergency Preparedness Tabletop Exercise | Kingman
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Thursday, August 25 - EPIC Water Management Training | Phoenix
For more information or to register for any of these events contact Krysten Dobson.
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Maricopa County Opens New COVID-19 Testing Sites
In response to increasing demand for COVID-19 testing, Maricopa County has opened multiple community testing sites across the Valley in February. Those include a new location at Ak-Chin Pavilion in partnership with City of Phoenix and staffed with resources through FEMA. The new daily PCR testing site at the Ak-Chin Pavilion is located near the Loop 101 and I-10 freeways, near several west Valley communities. The site is open 7 days per week from 11am-7pm, which is helpful for people who cannot easily access testing during regular business hours. Like many other MCDPH testing sites, this site takes people with and without appointments, and allows people to either drive through or walk up for testing. This site is operated in part with assistance from FEMA, who contracted a team to provide testing support. In addition to the Ak-Chin site, Maricopa County has worked with its vendors to open additional sites offering PCR testing across the Valley in the month of February:
- Daily at Tolleson Veterans Park in Tolleson
- Wednesdays and Thursdays at Scottsdale Community College in Scottsdale
- Saturdays and Sundays at Mesquite High School in Gilbert
Details of all Maricopa County-supported testing events are listed at:
People who need assistance finding a testing location or scheduling an appointment can also call the MCDPH CARES Team at (602) 506-6767 for assistance in multiple languages.
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Understanding Community Transition of COVID-19
As of February 2, 2022, 99.75% of all counties in the US have high community transmission of COVID-19. The CDC measures two numbers when determining the level of community transmission: total new cases and percent positivity.
Total new cases refer to a county’s rate of new COVID-19 infections, reported over the past seven days, per every 100,000 residents.
Percent positivity refers to the percentage of positive COVID-19 tests in a county of the past seven days. A higher number of total new cases and a higher percent positivity correspond with a higher level of community transmission.
Although COVID-19 vaccines authorized in the US are highly effective at limiting the spread of COVID-19 and preventing severe illness, vaccination in some parts of the country remains low. Layered prevention strategies – like masking- along with getting vaccinated can help further reduce the spread of COVID-19.
The CDC recommends that if a county is in high community transmission, everyone should wear a mask in public, indoor settings. Please keep this in mind as we progress through this pandemic.
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Omicron Variant Update
Public health leaders reported that as of January 24th, 96% of sequenced COVID-19 cases are the Omicron variant. Coronaviruses tend to mutate frequently and generally become more contagious and less severe. That is what we are seeing right now with Omicron. More variants are expected to emerge, however, as more people develop immunity through infection or vaccine, transmission, hospitalizations, and deaths are expected to decrease. Eventually COVID-19 will become endemic, meaning it will spread in more predictable ways and will cause less of a burden on our health care system.
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Join the Infection Preventionist Call - 2/24/22
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, February 24th at 1:00 pm.
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CMS Updates Nursing Home Visitation FAQs
- Suggestions on how to conduct visits that reduce the risk of COVID-19 transmission.
- Best practices for improving air quality to reduce risks during visitation.
- Ways a facility can improve and/or manage air flow during visitation.
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Availability of funding for environmental changes, which reduce the transmission of COVID-19. Facilities can request CMP reinvestment funds to purchase portable fans and portable room air cleaners with HEPA filters.
- Visitor testing as a condition of entering a facility.
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CMS Survey Resources Folder Updated
The CMS Survey Resources with Staff vaccine Documents (1-28-2022) has been updated. It now includes an updated Entrance Conference Worksheet, the new Staff Vaccination Matrix and an updated Infection Prevention, Control & Immunization CE pathway. The COVID-19 Focused Infection Control (FIC) Survey folder within the resources folder has also been updated. The FIC Entrance Conference worksheet has also been updated.
The Entrance Conference Worksheet and the FIC Entrance Conference Worksheets include instructions for surveyors to begin using them on February 14, 2022. These worksheet updates include that facilities will be asked:
- For a list of confirmed COVID-19 resident cases for the last 4 weeks.
- To indicate whether any of the resident cases resulted in hospitalization or death.
- To provide their COVID-19 Healthcare Staff Vaccination Policies and Procedures.
- To complete the new Staff Vaccination Matrix (or facilities may choose to provide a list containing the same information as required in the staff matrix).
The COVID-19 Focused Infection Control (FIC) Survey Protocol with Staff Vaccination Mandate was also updated and included in the resource folder. It includes information on how surveyors will survey for compliance with F888. Both the updated Infection Control & Immunization CE pathway and the FIC Survey Protocol with Staff Vaccination Mandate are great tools facilities can use to help ensure compliance. The complete requirement for F888 COVID-19 Vaccination of facility staff can be found at Attachment A. LTC.
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How Surveyors will Determine Compliance with F888
The CMS Infection Prevention, Control & Immunizations CE pathway will be used by the surveyors to determine compliance. Surveyors will obtain the facility’s staff COVID-19 data from NHSN and will compare it to the information provided by the facility in the COVID-19 Vaccination Matrix. The information should be reasonably consistent (10% or less difference). Surveyors will randomly (unless concerns exist for a specific staff member) select 8 staff members, two vaccinated and six unvaccinated from the COVID-19 Staff Vaccination Matrix. They will review documentation of the sampled staff member’s vaccination status, and if applicable exemptions and all supporting documentation.
Surveyors will review the facility’s policies and procedures to ensure all required components are present. They will also conduct observation and interviews to verify its implementation. Surveyors will observe and interview the selected unvaccinated staff to ensure additional precautions are in place to help prevent the spread of COVID-19. Surveyors will also review the facility’s contingency plan for staff who are not fully vaccinated and what actions the facility will take to obtain compliance.
The updated Infection Prevention, Control & Immunizations CE pathway with the complete details on how compliance will be determined can be found here and the complete requirement for F888 can be found at Attachment A LTC.
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CMS Issues Letter on the Importance of COVID-19 Staff Vaccinations
The Centers for Medicare and Medicaid Services Administrator Chiquita Brooks-LaSure issued a letter to health care facility administrators on the importance of COVID-19 staff vaccinations and the current CMS requirements. CMS recommends that facilities review the vaccine rule guidance released on December 28, 2021; January 14, 2022; and January 20, 2022 for additional information. information.
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Check out the Antibiotic Stewardship Video #3 in the Series
Take time to check out the final video in the antibiotic stewardship series featuring EPIC consultant Dr. Peter Patterson, our subject matter expert on antibiotic stewardship.
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Beware of Airborne Pollutants from Cooking Activities in Residential, Commercial and Institutional Kitchens
The kitchens that prepare and cook food in SNFs can be a significant source of indoor air pollution. Cooking particulates, combustion byproducts, water vapor and heat can all causes degradation of the indoor environment if there is a lack of adequate ventilation. Without appropriate make up air, the use of kitchen exhaust hoods can depressurize the building and promote the infiltration and migration of pollutants from other locations into an around the facility. Exhaust from kitchens can even cause outdoor air pollution issues in some crowded urban environments.
The U.S. Environmental Protection Agency (EPA) lists wood and gas stoves as sources of combustion products that impact indoor air quality (IAQ). These include carbon monoxide (CO), nitrogen dioxide (NO2) and particles. Natural gas and propane range tops and ovens can also release formaldehyde into the air. Even electric stoves can generate unhealthy air pollutants, such as polycyclic aromatic hydrocarbons (PAHs) and acrolein, from heating oil, fat and other food ingredients at high temperatures.
Regardless of the energy source, self-cleaning ovens can also create high levels of pollutants as food waste is burned away. Exposure to elevated levels of airborne pollutants from kitchens could exacerbate respiratory illnesses, as well as create other health concerns.
Reach out to the EPIC Industrial Hygiene Team for help to identify indoor and outdoor air pollution from cooking activities and work to find solutions to mitigate exposure risks. Our team can provide worksite assessments, ventilation inspections, air testing and monitoring services for particulate matter, organic chemicals, gases and odors from all types of kitchens. Our EPIC Industrial Hygiene partner, Clark Seif Clark, Inc. (CSC), sponsored an educational video about indoor air pollution from cooking that can be seen at: https://youtu.be/HI3drF4yY2U.
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Life Safety Compliance Continues to be a Challenge During the Pandemic
As the infection control fight continues in health care facilities, Life Safety Code (LSC) compliance continues to be an issue. Common deficiencies due to unsafe practices that have been observed in SNFs include improper storage practices, clutter within the means of egress and items that compromise the operation of a door. The excuse of, "we don't have any place to store all of our IC supplies" is not a sufficient reason to store items in your facility in a non-compliant manner and in unauthorized places. Storage must be neat and orderly as well as maintained at a height that provides 18 inches of vertical clearance from fire sprinkler heads within a protected room.
A "protected room" like a designated storage room is required to have one-hour fire-rated walls and a fire-rated door equipped with a self-closing device. Equipment and supplies should not clutter hallways in the building as the means of egress should be free and clear of obstructions to ensure safe evacuation in times of emergency.
Doors in your building that are equipped with self-closing devices should not be propped open or compromised in any manner that prevents them from properly closing and latching.
Infection control practices must be integrated into your operation without compromising Life Safety Code compliance. Contact Stan Szpytek, DR EPIC Consultant, with any specific life safety-related questions at Stan@azhca.org or (708) 707.6363.
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AzCHER Community-wide Full Scale Exercise Planned for April
As you may know, the Arizona Coalition for Health Care Emergency Response (AzCHER) will be conducting a community-wide/statewide full-scale exercise (FSE) on April 21, 2022. This will be a 4-hour exercise where registered facilities will be able to "play" at a level they will be comfortable with.
This exercise provides an opportunity to determine the viability and effectiveness of individual facility's Emergency Operations Plans (EOP). While this particular exercise is not solely focused on the pandemic, elements of COVID-19 will be a focus to help ensure that this exercise a 'real world' activity. There is no requirement to participate in the AzCHER FSE since CMS has made continuation of the COVID pandemic response an equivalency for the CMS-required, community-wide FSE. Facilities utilizing the PHE as their equivalency must develop proper documentation to illustrate their efforts including a comprehensive after-action report (AAR).
Participating facilities in the AzCHER FSE will be required to designate a controller and evaluator (they are non-players in the exercise) and provide their contact information on the exercise registration form.
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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 2022.
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