recovered from COVID-19 within the last 90 days AND remain asymptomatic, as well as for asymptomatic residents [who are up to date with all recommended COVID19 vaccine doses including any booster dose.] Residents who leave the NF for medically necessary appointments and return the same day are not considered to have unknown COVID-19 status. These residents’ COVID-19 status is the same as when they left the NF for their appointment and can return to their usual room. Page | 19 In general, all residents who are [not up to date with COVID-19 vaccine doses and are] new admissions or readmissions to the facility, or a resident who was gone overnight should quarantine, even if they test negative upon admission. Quarantine is no longer recommended for residents who are being admitted to a NF, if they are [asymptomatic and up to date with all recommended COVID-19 vaccine doses including any recommended booster dose] or have recovered from COVID-19 in the last 90 days. Those who do not quarantine should still watch for symptoms of COVID-19 for 14 days following an exposure. If they experience symptoms, they should be clinically evaluated for COVID-19, including testing for COVID-19, if indicated. Protocols for Persons Entering a Nursing Facility Under state and federal rules related to the COVID-19 public health emergency, providers must take certain precautions regarding persons who enter the facility. The precautions required can vary depending on the role and circumstances of the person entering the facility. Please read table: Protocols for Persons Entering a Nursing Facility regarding protocols for persons entering a nursing facility. This table outlines the necessary precautions for the groups of individuals who typically enter a facility and the corresponding requirements related to that person’s role. Page | 20 7.S.P.I.C.E. Recognizing notification of a potential COVID-19 situation in a NF can result in disorientation, questions, and confusion; this document suggests NFs focus on the following five basic actions (S.P.I.C.E.) to anchor activities: • Surveillance – Monitor for symptoms – fever, cough, shortness of breath, or difficulty breathing and other known COVID-19 symptoms. • Protection/PPE – Protect workforce and residents through appropriate hand hygiene and infection control procedures. If coughing or potential splash precautions are needed wear a mask, gown and face/eye shields. Refer to DSHS guidance. • Isolate – Residents with probable or confirmed cases need to be isolated. • Communicate – Call local health department/authority or DSHS and HHSC Long-term Care Regulation (LTCR) to report COVID-19 activity as required. • Evaluate – Infection control processes, spread of infection and mitigation efforts, and staffing availability need to be assessed. S.P.I.C.E. is not meant to be all-encompassing. It is suggested to assist initial actions and be a reminder of necessary activities. Page | 21 SPICE Graphic SPICE for COVID-19 Surveillance • Sign and Symptoms • Temperature Checks • Residents/Staff/Visitors • Testing Protection/Personal Protective Equipment • Clinical Staff • Support Staff • Resident • Supply/Burn-rate Isolate • Residents isolated • Staff Isolated • Others Isolated Communicate • Administrator Contact #: • Local Health Department #: • Department of State Health Services #: • Hospital Contact #: Evaluate • Review 0-24-hour checklist • Prevent delay of critical actions • Communication plan Page | 22 8.HHSC Long-term Care Regulation Activities with NFs that have Positive COVID-19 Cases For a report of a positive COVID-19 test (resident or staff) in a NF, HHSC will take the following steps: • Generate a priority 1 intake (must be investigated within 24 hours). • Conduct a focused review of facility infection control processes. • Communicate with the local health department/local health authority and DSHS. • Determine the number of residents probable or positive for COVID-19. • Determine the number of staff probable or positive for COVID-19. • Review facility isolation precautions and determine how residents are isolated in the NF (dedicated wing, private room) to ensure compliance with requirements. • Verify that upon the first positive test result of a NF staff member or resident, the NF worked with local health authorities, and DSHS to coordinate testing of all NF staff and residents. • Determine that all staff probable or positive for COVID-19 have been sent home and the NF knows to coordinate any return to work with the local health department. • Determine if facilities have sufficient PPE. • Determine if facilities are screening residents, staff and visitors. • Determine if others (e.g. contract staff) are also being tested. • Perform a call-down to all, other facilities in the county when staff at one facility tests positive for COVID-19. • Determine if facilities are following rules and regulations related to admission and discharge and are readmitting residents when appropriate. • Determine if staff, residents, and families are notified of positive COVID- 19 cases in the NF. • Track facilities by program type and number of positive and probable cases. • Track hospitalizations of COVID-19 positive NF residents. • Track deaths of COVID-19 positive NF residents. • Maintain communication with facilities after investigations are complete. • Read the CDC guidance on when to quarantine. 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