0.75mL Non-toxic Test-tube BD Veritor (BD) 0.1% sodium azide, Triton™ X-100, 0.325mL Harmful if inhaled, swallowed, or exposed to skin Test-tube Ellume ProClin® 300 Allergic skin reactions Dropper Flowflex (ACON) Sdoium Azide 0.02%, Triton™ X-100 Hazardous to skin/eye Test-tube CareStart (Access Bio) Sodium tetraborate, ETDA, Triton™ X-100, N-lauroylsarcosine, 0.5mL Eye irritant/damage, harmful if swallowed, skin irritation, toxic to aquatic life Test-tube iHealth Triton™ X-100 0.1%, ProClin™ 300 0.05% Skin/eye irritation, burns, allergic reactions Test-tube SCoV-2 Ag Detect (InBios) Tris(hydroxymethyl)aminomethane, Nonidet P-40, sodium dodecyl sulfate, sodium deoxycholate, EDTA (all Residents of NFs are more susceptible to COVID-19 infection and the detrimental impact of the virus than the general population. In addition to the susceptibility of residents, an LTC environment presents challenges to infection control and the ability to contain an outbreak, resulting in potentially rapid spread among a highly vulnerable population. This document provides NFs immediate actions to consider and actions for extended periods after a NF is made aware of potential infection of a resident, provider or visitor. Page | 12 4.Description of a Nursing Facility A NF provides institutional care to people whose medical condition regularly requires the skills of licensed nurses. NF services are available to people who receive Medicaid assistance or those who wish to private pay for their care.The NF must provide for the needs of each resident, including room and board, social services, over-the-counter medications, medical supplies and equipment, and personal needs items. A SNF is a special facility or part of a hospital that provides medically necessary professional services from nurses, physical and occupational therapists, speech pathologists, and audiologists. SNFs provide round-the-clock assistance with health care and activities of daily living. SNFs are used for short-term rehabilitative stays after a resident is released from a hospital. A hospital-based SNF is located in a hospital and provides skilled nursing care and rehabilitation services for people who have been discharged from that hospital but who are unable to return home right away. They do not accept general admissions. Page | 13 5.NFs and COVID-19 Environment A NF is typically a mix of semi-private and private resident bedrooms; the majority of the bedrooms are semi-private, housing two to four people. The bedrooms usually do not have physical barriers like walls or partitions separating the space allotted for each resident inside the room. Rules require a minimum of 100 square feet for a private (one person) bedroom, 80 square feet per person in multiple occupant rooms, and a minimum dimension of 10 feet. Many of the common areas in a NF are intended for use by groups of people. These areas include dining and living room spaces, activity and therapy areas, and common bathing units, which are provided at a ratio of one tub or shower for every 20 residents. Impact of environment on COVID-19 response: A typical NF is not physically designed to effectively support physical distancing measures, while at the same time housing numerous residents who might require quarantine measures including isolation. The limitations of the physical environment mean many of the protective measures required to limit potential exposure and spread must be accomplished by staff who are already working under extreme conditions. While adhering to the core principles of COVID-19 infection prevention and control, communal activities and dining can occur. Read section 14 for more information on activities and dining. Facility Demographics NFs are located in metropolitan, urban, and rural locales. Each locale has specific characteristics that affect workforce availability, health care system support, and interactions with public health, emergency care, and jurisdictional administration. Texas currently has 1,220 NFs and nine hospital-based SNF units. Impact of NF demographics on COVID-19 response: NFs in more densely populated locations are likely to experience higher risk for exposure among staff and visitors. As a result, these facilities have a higher risk of infection and face more challenges controlling spread when infection occurs. They are also more likely to face staffing shortages because of competitive job markets. NFs in more rural locations have less health care system support, might not have local health authorities, and have smaller staffing pools, making it harder to cover shortages that result from probable exposure. Facilities in rural areas might also be more challenged to find equipment, such as personal protective equipment (PPE) and ventilators, necessary to care for COVID-19 positive residents. Facility Considerations Facilities might have small, medium, or large bed capacity within buildings differing in age, size, available space, and equipment. Available services also differ by NF, Page | 14 affecting the level of available care; ventilator support might not be present, and the types of health care providers on site will alsovary. Impact of facility considerations on COVID-19 response: There are NFs with limited or no isolation rooms available. Statewide, approximately 30 NFs are equipped to care for residents on ventilators. Bed capacity (along with staff and PPE