Friday, January 14, 2022
EPIC Newsletter
For Arizona SNFs - Emergency Preparedness Infection Control
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.
Mark Your Calendars for Upcoming EPIC Events

  • Wednesday, January 19 - EPIC Infection Control Emergency Preparedness Tabletop Exercise | Tucson Register Here
  • Wednesday, March 23 - Annual Disaster Ready Summit | Phoenix
  • Thursday, May 5 - EPIC Infection Control Emergency Preparedness Tabletop Exercise| Kingman| Register Here
  • Wednesday, May 25 - EPIC Training: Antibiotic Stewardship Training | Flagstaff
  • Thursday, June 9 - EPIC Antibiotic Stewardship Training | Tucson
  • Wednesday, June 22 - EPIC Infection Control Emergency Preparedness Tabletop Exercise | Kingman
  • Thursday, August 25 - EPIC Water Management Training | Phoenix

For more information or to register for any of these events contact Krysten Dobson.
Important to Provide
COVID-19 Boosters

According to the CDC COVID-19 Vaccine Booster Shots | CDC the effectiveness of the COVID-19 vaccine to prevent infection or severe illness wanes over time especially in individuals 65 years and older and therefore a booster shot is needed. The COVID-19 booster shots increase the individual’s protection against COVID-19 infection and severe outcomes resulting from infection. With the emergence of Omicron, it is imperative to get as many residents and staff their booster shot as soon as possible. To make it easier for facilities to vaccinate their residents and staff the Arizona Department of Health Services is providing mobile immunization clinics statewide. If you would like a mobile COVID-19 booster event at your facility, please reach out to Jessie Barbosa, ADHS Vaccine Equity Manager, at healthequity@azdhs.gov or call (347) 542-3417. Jessie will work with you to schedule an event that meets your needs. 
Frequently Cited Deficiency: F884 Reporting to NHSN

The most frequently cited deficiency in Arizona this Federal Fiscal Year (FFY) 2022 is F884 -Reporting to NHSN, it has been cited 25 times so far. F884 requires the facility to report weekly confirmed or suspected cases of COVID-19, COVID-19 vaccine status of residents and staff, vaccine adverse events and therapeutics administered to residents to treat COVID-19 and other reporting as specified in CMS QSO-21-19-NH and CMS QSO-20-29-NH. One way to help ensure your facility stays incompliance with this requirement is to have at least two or more individuals able to enter data in to the COVID-19 Module | LTCF | NHSN | CDC. One of the most frequently stated reasons data was not entered by a facility is that no one has access, because the individual/s who submit the data were no longer with the facility or out on vacation or sick.  
CDC Guidance for Omicron Exposure and Work Restrictions

COVID-19 Exposure
In general, asymptomatic healthcare personnel (HCP) who have had a higher-risk COVID-19 exposure do not require work restriction if they have received all COVID-19 vaccine doses, including a booster dose, as recommended by the Centers for Disease Control and Prevention (CDC), and do not develop symptoms or test positive for SARS-CoV-2. HCP can return to work after day 7 following the exposure if a viral test is negative and no symptoms have developed. If a test is not taken, the HCP can return to work 10 days following the exposure. Refer to the CDC’s table “Recommended Work Restrictions for HCP Based on Vaccination Status and Type of Exposure” for more information.

COVID-19 Infection: Return to Work
HCP with asymptomatic COVID-19 may return to work after 7 days if a negative antigen or PCR COVID-19 test is obtained within 48 hours prior to returning to work. If no testing was conducted, HCP can return to work after 10 days. If a positive test result came back between days 5-7 then the HCP can return to work after 10 days (keep in mind that people can persistently test positive for COVID-19 even though they are no longer transmitting the infection, therefore a negative test is not recommended to be used to return to work after 10 days). HCP with mild to moderate illness can return to work under the same recommendations as those that are asymptomatic, however, they must also have improved symptoms, and have not taken any fever-reducing medications for at least 24 hours. Finally, HCP who have had severe to critical illness will need to wait 20 days to return to work since symptom onset, have improved symptoms, and have not taken any fever-reducing medications for at least 24 hours.
Again, check out this link to the table describing the guidance in detail.
Join the Infection Preventionist Call - 1/27/22

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, January 27th at 1:00 pm.
New Year's Resolutions for Antibiotic Stewardship

As we begin the new year – 2022 – it's a good time to conduct an annual review of your antibiotic stewardship program as part of the facility-wide assessment required by federal (CMS) regulation. The main updates to consider for stewardship include:
  1. Shift to tracking antibiotic prescribing events by clinical syndrome (UTI, Pneumonia, Round skin [pressure] wound), rather than by antibiotic class (Penicillins, aminoglycosides, etc.).
  2. Assess the clinical symptoms of each antibiotic prescribing event against a standard case definition (McGeer Criteria 2012 revision) and record whether each event meets a case definition. Track the fractions meeting (or not meeting) criteria for feedback reporting to prescribers (Physicians and Nurse Practitioners).
  3. Stewardship case finding can use the facility electronic record. Look for new antibiotic starts and new diagnostic test orders.

Meet with your leadership triad (Administrator, Director of Nurses and the Medical Director) to enlist their aligned support for regular feedback reports to prescribers. Contact Dr. Patterson at the EPIC Help Line for any questions or requests for assistance. Email the DR EPIC online Help Center at EPIC@azhca.org. You can also call the DR EPIC phone Helpline at 602-241-4644.
Check out the Next Antibiotic Stewardship Video in the Series

In last month’s newsletter we introduced you to EPIC consultant Dr. Peter Patterson, our subject matter expert on antibiotic stewardship. Check out the next short video in his series “The Truth About Antibiotic Stewardship.” Make time to learn more about this important component of infection control! 
Fast Moving Colorado Wildfire Emphasizes the Importance of Readiness

Emergencies and disasters don't always conform to traditional parameters in respect to scope, severity and duration. The protracted Public Health Emergency (PHE) associated with COVID-19 reminds us that disasters can linger for months or even years. The fast-moving wildfire that devastated communities north of Denver recently reveal natural disasters don't always prescribe to a seasonal schedule. Tornadoes in Phoenix? A power failure in Tucson or Winslow that lasts 4 weeks? A fast-moving wildfire in Scottsdale that threatens entire neighborhoods and long-term care facilities?  While these are scenarios that are all possible, they are often considered highly unlikely. Since its inception 10 years ago, the Disaster Ready program has emphasized the importance of "readiness." Emergency Preparedness is not simply a compliance requirement but rather a concept and culture designed to save lives and property. Is your facility and team Disaster Ready? For more information, contact Stan at stan@azhca.org.
Dangers Associated with Lithium Batteries
 
As facilities embrace new technologies to continuously and safely sanitize the environment of care, the use of battery-operated equipment has become very common. The hazards associated with the use and charging of lithium batteries should not be under-estimated. In 2019, OSHA released a Safety and Health Information Bulletin (SHIB) focused on preventing fire and explosion injuries from wearable devices that contain lithium batteries. Workers who wear or frequently handle lithium-powered devices or batteries may be at risk if the battery catches fire or explodes since the device or battery is close to the body. An example of such a device would be a sanitizing sprayer powered by lithium batteries.  A long-term care facility in California in 2020 experienced a significant fire in a housekeeping storage room that was caused by lithium batteries that were "over-charged" and exploded. The batteries were for ionization sprayers that were used for sanitizing surfaces.

   The OSHA bulletin provides prevention and training guidelines for employers:

  • Ensure lithium batteries, chargers, and associated equipment are tested in accordance with an appropriate test standard and certified by a Nationally Recognized Testing Laboratory (NRTL) and are rated for their intended uses. 
  • When replacing batteries and chargers for an electronic device, ensure they are specifically designed and approved for use with the device and are purchased from the device’s manufacturer or a manufacturer authorized reseller. 
  • Remove lithium-powered devices and batteries from the charger once they are fully charged.
  • Store lithium batteries and devices in dry, cool locations and in fire-resistant containers.
  • Avoid damaging lithium batteries and devices. Inspect them for signs of damage, such as bulging/cracking, hissing, leaking, rising temperature, and smoking before use, especially if they are wearable. Immediately remove a device or battery from service and place it in an area away from flammable materials if any of these signs are present.
  • If batteries are damaged, remove from service and dispose in accordance with local, state, and federal regulations. Contact a local battery recycling center for disposal instructions.
  • Ensure that an emergency action plan (EAP) for a workplace with lithium-powered devices or batteries includes lithium-related incident response procedures based on manufacturer’s instructions for responding to battery failures including fires or explosions. 
  • Ensure that appropriate information about the hazards of lithium-powered devices and lithium batteries is communicated to exposed workers (e.g., during repair of lithium-powered devices or during recycling activities) and that workers receive training on the physical and health hazards associated with lithium-ion and/or lithium-metal cells or batteries.
CMS Emergency Preparedness Annual Requirements

As a new year begins, it is important to remember that there are several "annual" requirements associated with CMS Emergency Preparedness compliance specifically for skilled nursing facilities. These requirements include comprehensive documentation to illustrate completion of annual review and updating of the following:
  • Emergency Plan (E-004)
  • Facility-based Hazard Vulnerability Assessment (E-006)
  • Community-based Hazard Vulnerability Assessment (E-006)
  • EP Policies and Procedures (E-013)
  • Arrangements with other facilities (E-025)
  • Communication Plan (E-029)
  • Contact Information (E-030)
  • Emergency Officials Contact Information (E-031)
  • Emergency Prep and Testing Program (E-036)
 
Additionally, the following annual requirements must be completed:

  • All Hazards Emergency Training for Staff (E-037)
  • Participation in a community-based, full-scale exercise (E-039)
  • Completion of an exercise of choice (E-039)
As your team looks forward to the new year, make sure that your EP compliance program includes time to complete all of these annual requirements to help ensure that your facility is Disaster Ready all year long. 
EPIC Q & A

Q: Can staff refuse to be tested for COVID-19?

A: Yes. However, CMS requires that “Facilities must have procedures in place to address staff who refuse testing. Procedures should ensure that staff who have signs or symptoms of COVID-19 and refuse testing are prohibited from entering the building until the return to work criteria are met. If outbreak testing has been triggered and an unvaccinated staff member refuses testing, the staff member should be restricted from the building until the procedures for outbreak testing have been completed. The facility should follow its occupational health and local jurisdiction policies with respect to any asymptomatic unvaccinated staff who refuse routine testing.” This answer is from CMS QSO-20-38-NH Revised 9/10/2021.
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.