SNFs, for the prevention, management, and reporting of COVID-19 outbreaks. Prompt recognition and immediate isolation of probable cases is critical to prevent outbreaks in residential facilities. Background Because of their congregate nature and residents served (older adults often with underlying medical conditions), NF populations are at the highest risk of serious illness caused by COVID-19. Every effort must be made to prevent the introduction and spread of disease within these facilities. People at high risk for developing severe COVID-19 include those who are 65 or older, immunocompromised (including cancer treatment), and have other high-risk conditions such as chronic lung disease, moderate to severe asthma and heart conditions. People of any age with severe obesity or certain underlying medical conditions, particularly if not well controlled, such as diabetes, renal failure, or liver disease might also be at risk. COVID-19 is most likely to be introduced into a NF by ill HCP or visitors. Long-term care facilities should implement appropriate visitor restrictions and enforce sick leave policies for ill staff. Immediate Prevention Measures Visitor restriction – On [March 10, 2022], CMS revised QSO 20-39, guidance on NF visitation. Visitation is now allowed for all residents at all times, per CMS. [HHSC no longer has emergency rules about visitation and NFs should refer to CMS QSO 20-39 as applicable.] Personnel, Contractors, Vendors – Review and revise how the NF interacts with vendors and delivery personnel, agency staff, EMS personnel and equipment, transportation providers (when taking residents to offsite appointments, etc.), and other non-health care providers (food delivery, etc.). This should include taking necessary actions to prevent any potential transmission. Essential services such as dialysis, interdisciplinary hospice care, organ procurement, or home health personnel should still be permitted to enter the NF provided they are wearing all appropriate PPE and undergo the same fever and symptom screening process as NF staff. Facilities can allow entry of these essential visitors after screening. Page | 29 Surveyors should not be restricted. CMS and state survey agencies are constantly evaluating their surveyors to ensure they don’t pose a transmission risk when entering a NF. For example, surveyors might have been in a facility with COVID-19 cases in the previous 14 days, but because they were wearing PPE effectively per CDC guidelines, they pose a low risk to transmission in the next facility and must be allowed to enter. Additionally, LTCR surveyors are tested for COVID-19 every two weeks and restricted from work until the criteria for the discontinuation of transmission-based precautions is met. However, there are circumstances under which surveyors should still not enter, such as if they have a fever or any additional signs or symptoms of illness. Making deliveries to residents at facilities – Families and other visitors can still deliver or bring items (i.e., food and clothes) to residents at facilities. Facilities should follow CDC guidance for appropriate disinfecting guidelines, depending on what the items are. For handling non-food items, the CDC recommends hand washing after handling items delivered or after handling mail. Resident laundry – While it is not recommended, family members and friends of residents are not prohibited from doing laundry. Facilities are required to have policies and procedures in place for staff to handle, store, process, and transport all linens and laundry in accordance with national standards to produce hygienically clean laundry and prevent the spread of infection to the extent possible. Active screening – The CDC and CMS recommend, and the NF COVID-19 Response rules require, NFs screen all staff prior to entering the NF at the beginning of their shift for fever and symptoms consistent with COVID-19. Actively take their temperature and document absence of or shortness of breath, new or change in cough, sore throat and other symptoms of COVID-19. If they are ill, have them put on a facemask per CDC guidance, immediately leave the NF, and self-isolate at home. Facilities should also screen any visitors who are permitted to enter the building, including visiting health care providers. [NFs are no longer required to maintain a screening log but may choose to do so voluntarily.] Read table Comparing Symptoms of COVID-19 Infection, Flu, and Seasonal Allergies for additional information on ruling out COVID-19 Education – Share the latest information about COVID-19 and read the CDC’s Interim Infection Prevention and Control Recommendations for Residents with Suspected or Confirmed COVID-19 in Healthcare Settings. Educate residents and families about COVID-19, actions the NF is taking to protect them and their loved ones and actions residents and families can take to protect themselves in the NF. Educate and train HCP and reinforce sick leave policies and adherence to infection prevention and control measures, including hand hygiene and selection and use of PPE. Have HCP demonstrate competency with putting on and removing PPE. Remind HCP not to report to work when ill. Educate facility-based and consultant personnel (wound care, podiatry, barber) and volunteers. Including consultants is important because they often provide care in Page | 30 multiple