COVID-19 is identified in the NF, conduct outbreak testing in accordance with QSO 20-38. Consider having HCP wear all recommended PPE for care of all residents (regardless of symptoms) on the affected unit (or facility-wide, depending on the situation). This includes: an N95 or higher-level respirator, eye protection, gloves, and gown. HCP should be trained on PPE use, including donning and doffing. Physical distancing - Remind residents to practice physical distancing in accordance with CMS and CDC guidance and perform frequent hand hygiene. Physical distancing means avoiding unnecessary physical contact and keeping a distance of at least 6 feet from other people. For residents with COVID-19 positive status and residents with unknown COVID-19 status, per CMS guidance, [residents, in isolation or quarantine should not participate in] group activities. Bathing and showering - NFs experiencing a COVID-19 outbreak should restrict resident movement while the NF is investigating and taking actions to stop the spread of the virus. Residents with active signs and symptoms of respiratory illness or COVID-19 should remain in their bedroom while being evaluated and treated. However, care services for other residents can be resumed once appropriate precautions have been implemented. Ideally, residents with COVID-19 should be accommodated in a separate unit, with separate bathing or showering facilities, designated for care of individuals with COVID-19. If the separate unit does not have separate bathing of showering facilities, the NF should at least designate a bath/shower area that is separate from the ones used for residents who do not have COVID-19. Alternately, the NF could use other strategies for ensuring resident safety while delivering care, including scheduling showering or bathing for residents with COVID19 at the end of the day so there would be less overlap with residents who do not have COVID-19. NFs should continue to follow existing CDC recommendations for cleaning and disinfection of equipment and surfaces in shared spaces, like common shower rooms or equipment that must be shared between residents, between every resident use, using the appropriate EPA-approved products for COVID-19 prevention. HCP should also be able to wear and maintain safe use of all recommended PPE while assisting residents with personal hygiene. Some PPE, including respirators and facemasks, could be compromised if they get wet. Residents who can bathe independently - If a resident is able to shower independently, they should continue to do so. Page | 35 Residents who need assistance to bathe - If a resident needs assistance with bathing and: • the resident has COVID-19 and is symptomatic or asymptomatic, HCP must also be able to wear and maintain safe use of all recommended PPE while assisting residents with personal hygiene; or • the resident has recovered from COVID-19, per the test-based or non-testbased strategy (or otherwise), OR the resident has consistently tested negative and is asymptomatic, follow established policies and procedures for other care that requires close contact for bathing and showering. Cleaning and disinfecting the bathing or shower area - If residents with COVID19 have access to a private bathroom or only share a bathroom with other residents who have the same COVID-19 status, the NF should clean and sanitize the bathroom frequently. If the bathing or showering area is shared by both residents who have COVID-19 and those who don’t, clean and disinfect the area between every resident use. Resident education - Educate residents and any visitors regarding the importance of hand hygiene. Assist residents in performing hand hygiene if they are unable to do so themselves. Education should also be provided to residents to cover their coughs and sneezes with a tissue, then throw the tissue away in the trash and wash their hands. Resident testing - Per CMS QSO 20-38, NFs must immediately test any resident, vaccinated or unvaccinated, displaying signs and symptoms of COVID-19. During outbreak conditions, the facility has the option to perform outbreak testing through two approaches, contact tracing or broad-based (e.g., facility-wide) testing until no new cases in staff or residents are identified. Residents who have previously recovered from COVID-19 in the last 90 days and remain asymptomatic do not need to be tested. Read QSO 20-38 for more information on outbreak testing. A resident or representative can exercise their right to decline COVID-19 testing. NFs should discuss COVID-19 testing with residents, and staff should use a personcentered approach when explaining the importance of testing for COVID-19. NFs must have procedures to address residents who refuse testing. Procedures should ensure that residents who have signs or symptoms of COVID-19 and refuse testing are isolated and placed on transmission-based precautions until the criteria for discontinuing transmission-based precautions have been met. If outbreak testing has been triggered and an asymptomatic resident refuses testing, the NF should be extremely vigilant, such as through additional monitoring, to ensure the resident maintains appropriate distance from other residents, wears a face covering, and practices effective hand hygiene until the procedures for outbreak testing have been