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.
Masking, or source control, can be used to cover a person’s mouth and nose to prevent spread of respiratory secretions when they are breathing, talking, sneezing or coughing. Masks should be well fitting, and those wearing respirators must be fit-tested to ensure a complete seal. For healthcare personnel, appropriate masks include N95 or higher-level respirators, KN95s, and surgical masks, not cloth masks.
Source control is recommended for anyone who:
For staff, residents, and visitors, masking recommendations are based on local COVID-19 trends:
When a resident is not suspected of having COVID-19, healthcare workers should follow standard precautions, including hand hygiene, respiratory etiquette, cleaning and disinfection, safe injection practices and the safe disposal of sharps. Local COVID-19 trends may impact the recommended PPE for staff in a long-term care facility.
When COVID-19 is not suspected in a resident, consider implementing broader use of PPE based on local COVID-19 trends:
When a resident tests positive for COVID-19, health care providers should follow standard precautions, and wear:
While routine testing of asymptomatic people is no longer recommended for long-term care facilities, people who are symptomatic or have had an exposure to COVID-19 should be tested. Anyone with even mild symptoms of COVID-19, regardless of vaccination status, should receive a viral test for SARS-CoV-2 as soon as possible.
COVID-19 Symptoms Include:
Residents who have had a COVID-19 exposure should receive a series of three viral tests to identify if they are infected. With the date of exposure being Day 0, testing should occur on Day 1, Day 3 and Day 5. COVID-19 testing should be discontinued if the resident tests positive at any point in the series. This testing sequence does not apply to LTCF staff, who should instead monitor for symptoms and wear a well-fitting mask for 5 days. Residents who are exposed to someone with COVID-19 should be tested according to the testing sequence below, and wear a well-fitting mask for 10 days.
Testing on Day 1 should not occur less than 24 hours post the exposure event. COVID-19 testing is not recommended for asymptomatic people who have recovered from SARS-CoV-2 infection in the prior 30 days. Testing of new admissions to nursing homes is at the discretion of the facility.
Isolation and Quarantine are infection prevention and control tools used to reduce the spread of COVID-19 in the general population and in long-term care facilities.
People who have been exposed to a pathogen enter quarantine, while those who have been exposed and tested positive enter isolation. Asymptomatic residents and staff are not required to quarantine following a COVID-19 exposure. Residents should instead be tested according to the sequence described above and wear a well-fitting mask for 10 days.
Staff who test positive for SARS-CoV-2 infection should not return to work until at least 3 days have passed since their symptom onset. COVID-19 testing in order to return to work is no longer required. Staff returning on Day 4 should wear a well-fitting face mask through Day 7 regardless of the severity of illness. For additional information on staff isolation, please review frequently asked questions.
| Asymptomatic | Mild to Moderate Symptoms | Severe to Critical Symptoms |
|---|---|---|
|
No Symptoms 3-Day Isolation With a well-fitting face mask through Day 7 |
Fever, cough, sore throat, etc. 3-Day Isolation With improved symptoms, 24 hours since last fever without fever-reducing medication, staff feeling well enough to return to work, and a well-fitting face mask through Day 7 |
E.g., Shortness of breath (>30 breaths per minute) 10-Day Isolation With improved symptoms, and 24 hours since last fever without fever-reducing medication |
Residents who test positive for SARS-CoV-2 infection should be isolated to their rooms for at least 10 days. When possible, this should be a single-person room with a dedicated bathroom and the door should be kept closed (if it is safe to do so).
Staff caring for positive residents should wear an N95 or higher-level respirator, a gown, gloves, and eye protection. Transport outside of the room should be limited to medically essential purposes. Facilities may consider designating units and staff in the facility to positive residents during an outbreak.
| Asymptomatic | Mild to Moderate Symptoms | Severe to Critical Symptoms |
|---|---|---|
|
No Symptoms 10-Day Isolation |
Fever, cough, sore throat, etc. 10-Day Isolation With improved symptoms and 24 hours since last fever without fever-reducing medication |
E.g., Shortness of breath (>30 breaths per minute) 10- to 20-Day Isolation With improved symptoms and 24 hours since last fever without fever-reducing medication |
Long-term care facilities should encourage everyone to remain up to date with all recommended COVID-19 vaccine doses. Healthcare workers, residents, and visitors should be offered resources and counseled about the importance of receiving the COVID-19 vaccine.
Older adults and people with weakened immune systems are at increased risk for severe disease, hospitalization, and death from COVID-19 and flu. They rely on YOU to keep them safe and healthy! See answers to the most commonly asked questions from staff working at long term care facilities in Fairfax Health District.
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