facilities and can be exposed to or serve as a source of pathogen transmission. Coordinate with your long-term care ombudsman to assist with education to residents and family members. To request help from an ombudsman statewide, call 1-800-252- 2412 or email ltc.ombudsman@hhsc.state.tx.us. Provide Supplies for Recommended Infection Prevention and Control Practices • Hand hygiene supplies: o Put alcohol-based hand sanitizer with 60–95 percent alcohol in every resident room (ideally inside and outside of the room) and other resident care and common areas (outside dining hall, in therapy gym). o Make sure sinks are well-stocked with soap and paper towels for handwashing. • Respiratory hygiene and cough etiquette: o Make tissues and facemasks available for people who are coughing. o Consider designating staff to steward those supplies and encourage appropriate use by residents, visitors, and staff. • Make necessary PPE available in areas where resident care is provided. Put a trash can near the exit inside the resident room to make it easy for staff to discard PPE prior to exiting the room or before providing care for another resident in the same room. Facilities should have supplies of: o Facemasks o N95 respirators (if available and the NF has a respiratory protection program with trained, medically cleared, and fit-tested HCP) o Gowns o Gloves o Eye protection (face shield or goggles). • Read the guidance in the section related to PPE use when caring for residents with COVID-19. • The NF is responsible for implementing a respiratory protection program compliant with the OSHA respiratory protection standard for employees if not already in place. The program should include medical evaluations, training and fit testing. • Develop an environmental cleaning and disinfection schedule: o Make sure EPA-registered, hospital-grade disinfectants are available to allow for frequent cleaning and disinfection of high-touch surfaces and shared resident care equipment. o Read List N on the EPA website for EPA-registered disinfectants that have qualified under EPA’s emergingviral pathogens program for use against COVID-19. Page | 31 o High-touch surfaces include items like doorknobs, light switches, handrails, countertops - clean and disinfect frequently o Workstations include items like computers, chairs, keypads, common-use items - clean and disinfect frequently o Equipment includes items like blood pressure cuffs, hoyer lifts and other shared equipment used for resident care - clean and disinfect after each use o Consider using a checklist or log Control Measures for Residents Most of the actions that can be taken to prevent or control COVID-19 outbreaks in NFs are not new and include increasing hand hygiene compliance among staff, residents, and their families through education and on the spot coaching, as well as providing facemasks and hand hygiene supplies at the entrance to the NF. Additional critical control measures are listed below: Monitoring - Ask residents to report if they feel feverish or have symptoms of respiratory infection and COVID-19. Actively monitor all residents upon admission for fever and respiratory symptoms (including shortness of breath, new or change in cough, sore throat, and oxygen saturation). If the resident has fever or symptoms, implement recommended infection prevention and control (IPC) measures. People with COVID-19 have had a wide range of symptoms reported – ranging from mild symptoms to severe illness. Symptoms may appear 2-14 days after exposure to the virus. People with these symptoms may have COVID-19: • Fever or chills • Cough • Shortness of breath or difficulty breathing • Fatigue • Muscle or body aches • Headache • New loss of taste or smell • Sore throat • Congestion or runny nose • Nausea or vomiting • Diarrhea Quarantine - a resident who has unknown COVID-19 status must quarantine per CDC guidance for long-term care facilities. Residents who are [up to date with all recommended COVID-19 vaccine doses including any booster dose and remain] asymptomatic do not have to quarantine. Residents who have recovered from COVID19 in the last 90 days AND remain asymptomatic do not have to quarantine. Residents who have had close contact with someone with COVID-19, regardless of vaccination status, should have a series of two viral tests for COVID-19 infection. In these situations, testing is recommended immediately (but not earlier than 2 days after exposure) and, if negative, again 5-7 days after the exposure. Page | 32 While the CDC has provided quarantine alternatives for the general public, quarantine for [10] days is recommended for new admissions or readmissions to the NF who are [not up-to-date], have not recovered from COVID-19 within the last 90 days and had close contact within 6 feet for a cumulative total of 15 minutes or more over a 24- hour period with someone with confirmed COVID-19. The CDC’s two [quarantine options] are: Option #1 - Quarantine can end after day 10 without testing if the person has experienced no symptoms as determined by daily monitoring. Option #2 - Quarantine can end after day 7 if the person tests negative on a viral test (i.e., molecular or antigen test) and has experienced no symptoms as determined by daily monitoring. The test must occur on day 5 or