Health Department

Fairfax County, Virginia

CONTACT INFORMATION: Our administration office at 10777 Main Street in Fairfax is open during regular business hours 8 a.m. - 4:30 p.m., Monday - Friday. Clinic services are not offered at this location.

TTY 711

10777 Main Street
Fairfax, VA 22030

Gloria Addo-Ayensu, M.D., M.P.H.,
Director of Health

COVID-19 Prevention and Mitigation for Long-Term Care Facilities

Since the COVID-19 outbreak began, the Fairfax County Health Department has been actively engaged with long-term care facilities to prevent and mitigate the spread of disease within these high-risk settings. Communal living situations, such as skilled nursing facilities and assisted living facilities, are high-risk for spread of COVID-19, as they are for many other respiratory illnesses. The Health Department has a specific role to both prevent and mitigate outbreaks in these settings.

Proactive Health and Safety Actions

The Health Department has established a dedicated team of employees who are focused on investigating and reducing risk in in these congregate care settings. This team includes public health nurses, epidemiologists, environmental health specialists and a physician.

We have contacted all of Fairfax County’s assisted living and skilled nursing facilities and provided education on COVID-19 prevention. This includes specific actions facilities should take with cleaning, visitor policy, staff policy, and residents to enhance infection prevention. Information was also provided about the importance of staff not working in multiple sites and materials were provided to decrease staff movement between facilities. 

A public health nurse is also proactively being deployed to all these facilities to provide in-person guidance to reinforce these infection prevention messages and organize respirator fit testing for staff.  Follow up visits are also available for fit testing of N-95 respirators, increasing environmental disinfection, and taking COVID-19 specimens for testing.

Responding to a COVID-19 Case

If a single case of COVID-19 is identified in a resident or staff member, the Health Department will investigate and work with the facility to prevent or limit further spread of infection. By the time an infection has been identified at a facility, and before a Health Department visit, others at the facility already may have been exposed and infected; by working with the facility and improving infection prevention the goal is to prevent further disease spread.

An experienced communicable disease public health nurse is assigned to the facility to lead an investigation and provide recommendations. A Rapid Response Team is dispatched to the facility to provide training on appropriate personal protective use, taking nasopharyngeal specimens for lab testing, environmental disinfection, and infection prevention practices. A liaison public health nurse is also assigned to each facility and visits each day to observe infection prevention, make recommendations for improvement and provide support. 

As testing capacity has increased, the Health Department has instructed all assisted living and skilled nursing facilities to proactively test any resident who has respiratory symptoms for COVID-19. To help facilitate this, we are training staff on collecting specimens and have conducted tests for symptomatic patients, most at no cost, at the Health Department’s laboratory. Tests can also be conducted by a commercial laboratory. 

Point Prevalence Testing

The Health Department added another layer of infection prevention for long term care facilities in accordance with guidance from the Virginia Department of Health and the new availability of testing resources. We have reached out to every skilled nursing facility in Fairfax County to offer Point Prevalence Surveys, which is point in time testing of asymptomatic residents and staff to identify who is infected. 

Test results will help facilities identify where to best locate residents who test negative and those who test positive, and how to provide staffing in a way that reduces the risk of infection spreading. This approach, called “cohorting” is used along with other infection control measures such as the use of personal protective equipment by staff, isolation of infected residents, environmental disinfection, and good handwashing by everyone at the facility. Facilities will be prioritized for testing based on the characteristics of their outbreak, the level of risk to residents and staff, and collaboration by the facility. Therefore, we are unable to share when or where testing will take place.

Testing is not a panacea for infection prevention in long-term care facilities; it is one tool that adds to other layered measures. Testing only provides information about infection at one point in time. It also may not detect infection early in its course when the virus may not yet be at a level sufficient to be detected by the test. At all of these facilities, we continue to test those who develop illness and to reach out to facilities with COVID-19 positive cases who have not completed Point Prevalence Surveys.

In addition to these tests offered by the Health Department, facilities have tested residents and/or staff on their own using commercial labs and the University of Virginia laboratory.

While the Health Department is working intensively with facilities to prevent COVID-19 infections, additional residents may become ill despite the infection prevention measures being taken. Because there may be a week or more between the time someone is exposed and when that person becomes ill, the virus already may have spread before the heightened infection prevention measures were implemented. Prevention is an ongoing process and we continue to collaborate with facilities to make progress on all fronts to reduce the risk for residents.

See guidance from the Virginia Department of Health.

Why are these places at greater risk?

Assisted living facilities and skilled nursing facilities are considered high-risk for potential disease outbreaks for the following reasons.

  1. Residents of these facilities have a greater likelihood to have underlying medical conditions, and people with underlying medical conditions, such as lung issues, asthma, diabetes or obesity, are at greater risk for more severe COVID-19 infection.
  2. Residents of these facilities, by nature of age fall into the high-risk category for contracting severe symptoms of COVID-19.
  3. Residents in skilled nursing facilities may depend on staff for multiple close interactions such as getting out of bed, assistance with mobility, etc.
  4. Because of the large number of staff needed to care for residents and community transmission, there is a risk that someone will be infected but not ill and inadvertently bring the virus into the community.
  5. Staff of these facilities frequently work other jobs and might inadvertently spread disease from one facility to another facility.

If you are concerned that you or a loved one who is a resident might have been exposed to COVID-19, please contact your facility’s administration.

Additional information about COVID-19 outbreaks in nursing homes, assisted living, and multi-care facilities is available from the Virginia Department of Health

Guidance for Long Term Care Facilities

To reduce the risk of COVID-19 at your facility, the following measures should be implemented and enforced in all Fairfax County long term care facilities whether or not they currently have a resident or staff member with COVID-19.

If a COVID-19 case is identified in a resident or staff member at your facility, the Health Department will work with you directly and provide additional guidance.

Visitor Policies

  • No visitors should be allowed other than contracted and trained caregivers and for end-of-life or hospice care. Facilitate communication via phone or videoconferencing for residents.
  • Any visitor to the facility for contracted caregiving, end-of-life or hospice care should be checked for fever (temperature of >38.0 C [100.4 F]) and respiratory symptoms before entering the facility; if fever or cough is present, they should be denied entrance.
  • Restrict all volunteers, non-essential healthcare providers, and other non-essential personnel (e.g. barbers).

Staff Policies

Note: All policies for staff refer not only to employees but also to contract personnel at the facility such as therapists, meal service, and cleaning personnel.

  • It is highly recommended that staff refrain from working at more than one facility because of the risk of transmitting infection between work locations. Management should ask each staff person whether they work at another facility and, if so, ensure the staff person chooses a single facility to work at. This should also include administrators who may work at multiple locations.
  • All staff should be educated about the risk of COVID-19 to the LTCF patient population and measures that can be taken to reduce the risk of infection for themselves and residents.
  • Staff should be reminded not to congregate in work areas or break rooms and to maintain social distancing of 6 feet or more.
  • To the extent possible, staff should be cohorted to a single floor or, ideally, to a single unit, during and across work shifts.
  • All staff should have temperature checks and be asked about respiratory symptoms before beginning each shift. Results should be recorded on a log, checked for completeness, and kept at the facility (See sample staff monitoring log). Any staff with a temperature of >38.0 C (100.4 F) should be sent home immediately with appropriate guidance.
  • Use of Personal Protective Equipment (PPE) when caring for residents with possible COVID-19 – who have fever, cough or shortness of breath and who are not yet tested – should include gown, gloves, facemask (i.e., surgical mask) and eye protection when working directly with the resident. When able to remain at 6 feet or greater from the resident, no PPE is needed and when 3-6 feet from the resident, only a facemask is needed. A fit-tested N95 respirator is recommended rather than a facemask for direct care or diagnostic specimen collection of an unmasked suspect COVID-19 resident (See VDH PPE guidance for shortage situations). When such a situation is warranted, contact the Health Department for additional guidance.
  • Facemasks (i.e., surgical mask) can be reused between residents and between shifts if not soiled; place the facemask in a paper bag between uses and ensure good handwashing before and after touching a used facemask. Eye protection can be cleaned with a disinfectant wipe or solution and reused.
  • Encourage and periodically monitor frequent handwashing with soap and water or use of alcohol-based hand sanitizer (with >60% alcohol). Encourage handwashing before and after direct contact with a resident. Also encourage other preventive actions such as covering coughs and sneezes and post signage reinforcing this messaging.
  • Sick leave policies should be enforced for ill staff and they should be strongly reminded to contact their supervisor and not to attend the facility if they are symptomatic with respiratory symptoms consistent with COVID-19.

Resident Policies

  • All residents should be monitored at least daily for fever (temperature of >37.2 C [99.0 F]), cough and shortness of breath. Results should be recorded on a log, checked for completeness by management or designee, and kept at the facility (See Sample resident monitoring log).
  • Identify a clear process for residents to report if they feel feverish or have symptoms of respiratory illness
  • Any resident with fever, cough or shortness of breath should immediately be isolated in their room with the door closed.
  • All group activities for residents should be canceled and when residents are in common areas, they should remain at least 6 feet apart. Staff should continually provide reminders about the importance of social distancing.
  • Therapy rooms should be closed, as proper disinfection of therapy equipment between residents cannot be ensured. Therapy may continue in resident rooms if they have equipment dedicated to them.
  • Residents should have their meals in their rooms rather than in a dining area. If there are a small number of residents who require observation during meals to ensure their safety, they should be at least 6 feet apart and the area around where they sit should be disinfected following the meal.

Environmental Policies

  • Use an Environmental Protection Agency (EPA) List N disinfectant to clean hard surfaces at the facility with more frequent cleaning of high touch areas (doorknobs, light switches, shared computer keyboards, etc.).
  • Provide tissues, trash cans and hand sanitizer throughout the facility to facilitate protective behaviors. Use appropriate signage to support personal protective behaviors.

Testing, Reporting and Communication with the Health Department

  • Based on the daily screening recommended above, if you identify a single resident or staff person who has severe respiratory illness consistent with COVID-19 or three or more residents and/or staff with COVID-19-like illness within a 72 hour period, contact the Health Department immediately at 703-246-2433.
  • If a facility has a resident identified with COVID-19-like symptoms (fever, cough or shortness of breath) who is severely ill and needs emergency medical care, the facility should follow their usual procedures and ensure that when an ambulance is called, they are aware the resident may have COVID-19.
  • If a resident has fever, cough or shortness of breath and the situation does not require transport to the hospital, please complete an online form to request COVID-19 diagnostic testing. The Health Department will follow-up with you regarding each online request.
  • If a respiratory disease outbreak is identified or suspected (see above), contact the Health Department immediately at 703 246-2433.
  • Facilities with questions about COVID-19-like illness among staff or residents can contact the Health Department at 703-246-2433.
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