isolation or quarantine will depend on how many residents require isolation or quarantine. The facility is not required to have an entire unit, hallway, or wing dedicated to isolation or quarantine, especially as the number of residents in each cohort changes over time. • However, the NF COVID-19 Emergency Response Rule requires residents to be cohorted according to their COVID-19 status (positive, negative, unknown) AND requires a facility to have a response plan that includes cohorting plans with designated spaces for residents of each COVID-19 status. • If the facility does not currently have a designated hot zone for residents with a positive COVID-19 status, or a warm zone for residents with an unknown COVID-19 status, they must still be prepared to cohort and isolate or quarantine residents, should the need arise (e.g., outbreak in the facility, resident who tests positive for COVID-19). • An entire quarantine unit and/or an entire isolation unit may be needed if cases continue to increase at the facility, and at different times throughout this pandemic. Page | 26 Note: [Temporary walls or barriers are not required and the waiver permitting temporary walls or barriers ended on 06/06/2022.] If possible, the isolation space should be separated so the essential NF personnel maintaining the building or providing services to residents in the isolation space are not required to go through areas where negative or asymptomatic residents are receiving care. • Provide hand hygiene areas as needed, including inside and outside of the entrance to isolation area when possible. • Provide separate spaces to don (put on) and doff (take off) PPE when possible. Read PPE Donning and Doffing Infographic about donning (putting on) and doffing (taking off) PPE. • When a single area is provided for donning and doffing PPE, these principles should be followed: o Provide for hand hygiene and adequate disposal of used PPE in the donning and doffing area o Only donning or doffing should occur at any given time – do not perform these activities at the same time o Only two people should be in the area at any time - use the buddy system to assure that donning and doffing is done correctly • Use a private bedroom with its own bathroom for each resident when possible. • Use a semi-private bedroom and cohort COVID-19 positive residents if necessary. If a resident with COVID-19 has another infectious disease that requires transmission-based precautions, they need to be in a single occupancy room. • Accommodate a resident in the same bedroom for their entire stay while in the isolation [area] when possible. • Limit resident transport and movement to medically essential purposes only. • Use dedicated HCP and staff for the isolation area if possible. • Minimize traffic in and out of the isolation area. • Provide dedicated areas within the isolation area for HCP and staff use, including medication rooms, and supply rooms. • Provide adequate staff with training, skills, and competencies for COVID- 19 care. • Provide dedicated and adequate PPE, supplies and equipment for use in the isolation area. • Train HCP and staff on proper use and maintenance of PPE per CDC guidance. • Use dedicated staff to provide meal service and cleaning in the isolation area if possible. • Offer residents the option to bring along any belongings they choose. Ensure transferred items are disinfected before they are moved out of the isolation area. HCP/staff leaving and entering isolation room Page | 27 • Before entering the isolation room and prior to donning PPE, perform hand hygiene • Put on proper PPE. Read PPE Donning and Doffing Infographic for donning and doffing procedures. • Perform hand hygiene before and after performing resident care • Directly before exiting the isolation room, remove all PPE except respirator [and face shield or goggles], in accordance with donning and doffing procedures in PPE Donning and Doffing Infographic • [After exiting the isolation room, perform hand hygiene • Doff eye protection, then respirator respectively. Perform hand hygiene after removing the respirator] Protect from infection • Enact PPE plans • Determine PPE supplies • Screen residents, staff and visitors • Limit staff in contact with infected or exposed Care for residents who are infected • Isolate residents who are infected • Identify cohorts with the same status (exposed, infected) • Determine level of required care • Determine if hospitalization and transport are required • Notify local health care/EMS • Track signs/symptoms Note: While the updated NF COVID-19 Emergency Rule no longer requires dedicated staff for each resident cohort, the sharing of staff among different cohorts has the potential for increased transmission of COVID-19. If the NF provider is sharing staff, they must ensure they are following all infection prevention and control policies, as outlined by the CDC and CMS. The CDC still maintains that, if possible, staff should avoid working on both the COVID-19 care unit and other units during the same shift. CMS QSO 20-39 outlines the Core Principles of Infection Prevention. HHSC ACTIONS Read Section 8: HHSC Long-term Care Regulation Activities with NFs that have Positive COVID-19 Cases Page | 28 11. Interim Guidance for Prevention, Management, and Reporting of COVID-19 Outbreaks in LTC Facilities Purpose This document provides guidance to NFs, including nursing homes and