it is being updated often.) • Review resident isolation and quarantine plans with staff. • In general, all staff should continue to wear source control while at work, per CMS and the CDC guidance. However, in facilities located in counties with low to moderate community transmission, [staff who are up to date with all recommended COVID-19 vaccine doses including any booster dose] may choose to not wear source control or physically distance when they are in welldefined areas that are restricted from resident access (e.g., staff meeting rooms, kitchen). To determine the level of COVID-19 transmission in the community where a nursing facility is located, visit the CDC’s COVID-19 Data Tracker. If the two indicators suggest different transmission levels, the higher transmission level is used. Page | 17 [Staff Source Control use and Physical Distancing in Certain Areas*] Staff Vaccination Status Is Source Control Required Based on Community Transmission Level High to Substantial Low to Moderate Unvaccinated Yes Yes Fully Vaccinated (Not up to date) Yes Yes Up to Date Yes Optional Up to Date Staff When “Not Up to Date” Staff Are Present Yes Optional * In well-defined areas that are restricted from resident access. • Staff who have been appropriately trained and fit-tested can use N95 respirators. Staff who are caring for residents with COVID-19 or caring for residents in [counties with substantial or high transmission] should wear an N95 respirator and all CDC suggested PPE [during all resident care encounters]. Read the guidance in the section related to PPE use when caring for residents with COVID-19. • Actively screen, monitor, and surveil everyone who comes into the NF. • To avoid transmission within facilities, NFs should use separate staffing teams for COVID-19-positive residents to the best of their ability and designate separate facilities or units within a NF to separateresidents into three categories: those who are COVID-19-negative, those who are COVID-19- positive, and those with unknown COVID-19 status. A NF is not required to have a unit for residents who are COVID-19 positive or a unit for residents who have an unknown COVID-19 status at all times if the NF does not have any residents with unknown or positive status. Rather, the NF must have a response plan that includes cohorting plans with designated spaces for residents of each COVID-19 status (positive, negative and unknown). If the NF has repurposed their former warm and hot units for residents with a negative COVID-19 status, they must still be prepared to cohort and isolate or quarantine residents, should the need arise (e.g., outbreak in the NF, resident who tests positive for COVID-19). • Quarantine residents with symptoms of COVID-19 per CDC Guidance. Note: All residents with unknown COVID-19 status must be quarantined per CDC guidance. Residents who are [up to date with all recommended COVID-19 vaccine doses including any booster dose], and [remain] asymptomatic do not have to Page | 18 quarantine. CDC guidance offers two options for people without symptoms to be able to shorten their quarantine. Read Control Measures for Residents and Control Measures for Staff for more information. • Isolate residents with positive cases according to CDC Guidance. • Communicate with residents, staff, and family when exposure to probable or confirmed cases occur in the NF. • Develop and implement a policy regarding staff working with other LTC providers that limits the sharing of staff with other LTC providers, unless required in order to maintain adequate staffing at a facility. • Require staff self-monitoring on days they work and on days they don’t work. • Require staff to report via phone prior to reporting for work if they have known exposure or symptoms. • Follow the guidance under Control Measures for Staff to determine when staff can return to work after recovering from an illness. • Post a list of state contacts where it is visible on all shifts. The list should at least include phone numbers for the local health authority or DSHS office and the regional HHSC LTCR office. • Follow physician’s plan for immediate care of any resident with a positive case. Orders can include increased assessment frequency, increased monitoring of fluid intake and output, supportive care, a treatment plan, and what to do in case of a change in the resident’s status. • Read and follow plans for TB Screening and testing for healthcare personnel and residents. • Inform the resident of treatment or supportive care plans; residents have the right to participate in care planning. • Use the ASPR TRACIE workforce virtual toolkit. • Read the ASPR TRACIE resources document: Nursing Home Concepts of Operations for Infection Prevention and Control • Read CDC guidance on Infection Control after Vaccination Note: New admissions, readmissions, and residents who have spent one or more nights away from the NF are all considered residents with unknown COVID-19 status. All residents with unknown COVID-19 status must be quarantined per CDC guidance for long-term care facilities. [Follow the guidance in CMS QSO 20-39 to determine whether to test the resident for COVID-19, regardless of vaccination status, if a resident reports possible close contact to an individual with COVID-19 while outside of the nursing facility.] CDC guidance provides exceptions to quarantine for those who have