Boyd Nursing & Rehabilitation is proud to recognize Danny Chapman’s Success Story!

Mr. Danny Chapman was admitted to Boyd Nursing for rehabilitation in October, following complications of a respiratory failure and discharge from Hospice care. Upon admission, Mr. Chapman presented with decreased strength and activity tolerance, balance deficits and immobility, and required extensive assistance with his activities of daily living. Given the complexity of his situation, Mr. Chapman required medication management, lab monitoring, physical therapy, occupational therapy, and speech therapy services in order to restore him to a level to return home with the support of his loving wife.

Despite all the obstacles, this did not damper Mr. Chapman’s will to return home to his family. He worked diligently to overcome what seemed impossible at the start of his recovery. With the help of his physical, occupational, and speech therapists, Danny regained his strength and mobility to perform transfers and ambulation. He also regained his ability to perform self-care activities. This improvement enabled him to return home with his family. Congratulations, Mr. Chapman! We are so happy to have been able to assist you during your recovery.

Summary of Recent Changes

• Updated outbreak response guidance to promote use of contact tracing approach. Alternative broad-based approaches to outbreak response at a facility-wide or unit level are also described.
• Updated expanded screening testing recommendations for healthcare personnel (HCP).
• Updated recommendations for quarantine of fully vaccinated residents.
• Updated visitation guidance.

Key Points

• Older adults living in congregate settings are at high risk of being affected by respiratory and other pathogens, such as SARS-CoV-2.
• A strong infection prevention and control (IPC) program is critical to protect both residents and healthcare personnel (HCP).
• Even as nursing homes resume normal practices, they must sustain core IPC practices and remain vigilant for SARS-CoV-2 infection among residents and HCP in order to prevent spread and protect residents and HCP from severe infections, hospitalizations, and death.

In general, healthcare facilities should continue to follow the IPC recommendations for unvaccinated individuals (e.g., use of Transmission-Based Precautions for those that have had close contact to someone with SARS-CoV-2 infection) when caring for fully vaccinated individuals with moderate to severe immunocompromise due to a medical condition or receipt of immunosuppressive medications or treatment.

Other factors, such as end-stage renal disease, likely pose a lower degree of immunocompromise and there might not be a need to follow the recommendations for those with moderate to severe immunocompromise. However, fully vaccinated people in this category should consider continuing to practice physical distancing and use of source control while in a healthcare facility.

Ultimately, the degree of immunocompromise for the patient is determined by the treating provider, and preventive actions are tailored to each individual and situation.

Infection Prevention and Control Program

Assign one or more individuals with training in infection control to provide on-site management of the IPC program.

• This should be a full-time role for at least one person in facilities that have more than 100 residents or that provide on-site ventilator or hemodialysis services. Smaller facilities should consider staffing the IPC program based on the resident population and facility service needs identified in the IPC risk assessment.
• CDC has created an online training course that can orient individuals to this role in nursing homes.

Provide supplies necessary to adhere to recommended IPC practices.

• Ensure HCP have access to all necessary supplies including alcohol-based hand sanitizer with 60-95% alcohol, personal protective equipment (PPE), and supplies for cleaning and disinfection.
  • Put FDA-approved alcohol-based hand sanitizer with 60-95% alcohol in every resident room (ideally both inside and outside of the room) and other resident care and common areas (e.g., outside dining hall, in therapy gym).

Educate residents HCP, and visitors about SARS-CoV-2, current precautions being taken in the facility, and actions they should take to protect themselves.

Vaccinations

Vaccinated residents and HCP against SARS-CoV-2

• Vaccination acceptance among nursing home personnel remains low, but is critical to protect both staff and residents against COVID-19. CDC continues to stress the importance of getting vaccinated when it is offered to you.
• Per CMS requirements, weekly vaccination numbers of nursing home residents and HCP must be reported into the NHSN LTCF Weekly HCP & Resident COVID-19 Vaccination Reporting module.

Source Control and Physical Distancing Measures

Refer to Interim Infection Control Recommendations for Healthcare Personnel During the COVID-19 Pandemic for details regarding source control and physical distancing measures recommended for vaccinated and unvaccinated HCP and residents.

Visitation

Have a plan for visitation

• Send letters or emails to families and post signs at entrances reminding them of the importance of getting vaccinated, recommendations for source control and physical distancing and any other facility instructions related to visitation, including not to visit if they have any of the following:
  • A positive viral test for SARS-CoV-2,
  • Symptoms of COVID-19, or
  • If they currently meet criteria for quarantine

• Facilitate and encourage alternative methods for visitation (e.g., video conferencing) and communication with the resident.

Additional information about visitation for nursing homes and intermediate care facilities for individuals with intellectual disabilities and psychiatric residential treatment facilities is available from CMS.

Personal Protective Equipment

Ensure proper use, handling and implementation of personal protective equipment

• Information is available
  • Infection Control: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) | CDC
  • Personal Protective Equipment: Questions and Answers | CDC
  • Optimizing Personal Protective Equipment (PPE) Supplies (cdc.gov)

Testing

Create a plan for testing residents and HCP for SARS-CoV-2

• Anyone with even mild symptoms of COVID-19, regardless of vaccination status, should receive a virus test as soon as possible.
• Asymptomatic HCP with a higher-risk exposure and residents with close contact with someone with SARS-CoV-2 infection, regardless of vaccination status, should have a series of two viral tests for SARS-CoV-2 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. Criteria for use of post-exposure prophylaxis are described elsewhere.

Evaluating and Managing Personnel and Residents

Identify space in the facility that could be dedicated to monitor and care for residents with confirmed SARS-CoV-2 infection

• Determine the location of the COVID-19 care unit and create a staffing plan.
• The location of the COVID-19 care unit should ideally be physically separated from other rooms or units housing residents without confirmed SARS-CoV-2 infection. This could be a dedicated floor, unit, or wing in the facility or a group of rooms at the end of the unit that will be used to cohort residents with SARS-CoV-2 infection.
• Identify HCP who will be assigned to work only on the COVID-19 care unit when it is in use. At a minimum, this should include the primary nursing assistants (NAs) and nurses assigned to care for these residents. If possible, HCP should avoid working on both the COVID-19 care unit and other units during the same shift.
  • To the extent possible, restrict access of ancillary personnel (e.g., dietary) to the unit.
  • Ideally, environmental services (EVS) staff should be dedicated to this unit, but to the extent possible, EVS staff should avoid working on both the COVID-19 are unit and other units during the same shift.
  • To the extent possible, HCP dedicated to the COVID-19 care unit (e.g., NA and nurses) will also be performing cleaning and disinfection of high-touch surfaces and shared equipment when in the room for resident care activities. HCP should bring an Environmental Protection Agency (EPA)- registered disinfectant (e.g., wipe) from List N into the room and wipe down high-touch surfaces (e.g., light switch, doorknob, bedside table) before leaving the room.

Manage Residents with Close Contact

Manage residents who had close contact with someone with SARS-CoV-2 infection

• Unvaccinated residents who have had close contact with someone with SARS-CoV-2 infection should be placed in quarantine for 14 days after their exposure, even if viral testing is negative. HCP caring for them should use full PPE (gowns, gloves, eye protection, and N95 or higher-level respirator).
  • Although not preferred for healthcare settings, options for shortening quarantine are available.
• Fully vaccinated residents who have had close contact with someone with SARS-CoV-2 infection should wear source control and be tested as described in the testing section. Fully vaccinated residents and residents with SARS-CoV-2 infection in the last 90 days do not need to be quarantined, restricted to their room, or cared for by HVP using the full PPE recommended for the care of a resident with SARS-CoV-2 infection unless they develop symptoms of COVID-19, are diagnosed with SARS-CoV-2 infection, or the facility is directed to do so by the jurisdiction’s public health authority. Additional potential exceptions are described here.

Definitions:

Healthcare Personnel (HCP): HCP refers to all paid and unpaid persons serving in healthcare settings who have the potential for direct or indirect exposure to patients or infectious materials, including body substances (e.g., blood, tissue, and specific body fluids); contaminated medical supplies, devices, and equipment; contaminated environmental surfaces; or contaminated air. HCP include, but are not limited to, emergency medical service personnel, nurses, nursing assistants, home healthcare personnel, physicians, technicians, therapists, phlebotomists, pharmacists, dental healthcare personnel, students and trainees, contractual staff not employed by the healthcare facility, and persons not directly involved in patient care, but who could be exposed to infectious agents that can be transmitted in the healthcare setting (e.g., clerical, dietary, environmental services, laundry, security, engineering and facilities management, administrative, billing, and volunteer personnel.)

Source Control: Use of well-fitting cloth masks, facemasks, or respirators to cover a person’s mouth and nose to prevent spread of respiratory secretions when they are breathing, talking, sneezing, or coughing. Cloth masks, facemasks, and respirators should not be placed on children under the age of 2, anyone who cannot wear one safely, such as someone who has a disability or an underlying medical condition that precludes wearing cloth masks, facemask, or respirator safely, or anyone who is unconscious, incapacitated, or otherwise unable to remove their cloth mask, facemask, or respirator without assistance. Face shields along are not recommended for source control.

Respirator: A respirator is a personal protective device that is worn on the face, covers at least the nose and mouth, and is used to reduce the wearer’s risk of inhaling hazardous airborne particles (including dust particles and infectious agents), gases, or vapors. Respirators are certified by CDC/NIOSH, including those intended for use in healthcare.

Nursing Home-onset SARS-CoV-2 Infection: refers to SARS-CoV-2 infections that originated in the nursing home. It does not refer to the following:

• Residents who were known to have SARS-CoV-2 infection on admission to the facility and were placed into appropriate Transmission-Based Precautions to prevent transmission to others in the facility.
• Residents who were placed into Transmission-Based Precautions on admission and developed SARS-CoV-2 infection within 14 days after admission.

To learn more, please visit https://www.cdc.gov/coronavirus/2019-ncov/hcp/long-term-care.html

COVID-19 vaccines are effective at preventing infection, serious illness, and death. Most people who get COVID-19 are unvaccinated. However, since vaccines are not 100% effective at preventing infection, some people who are fully vaccinated will still get COVID-19.

An infection of a fully vaccinated person is referred to as a “vaccine breakthrough infection”.

Key Points

• COVID-19 vaccines protect everyone ages 5 years and older from getting infected and severely ill, and significantly reduce the likelihood of hospitalization and death.
• Getting vaccinated is the best way to slow the spread of COVID-19 and to prevent infection by Delta or other variants.
• A vaccine breakthrough infection happens when a fully vaccinated person gets infected with COVID-19. People with vaccine breakthrough infections may spread COVID-19 to others.
• Even if you are fully vaccinated, if you live in an area with substantial or high transmission of COVID-19, you – as well as your family and community – will be better protected if you wear a mask when you are in indoor public places.
• People who are immunocompromised may not always build adequate levels of protection after an initial 2-dose primary mRNA COVID-19 vaccine series. They should continue to take all precautions recommended for unvaccinated people, until advised otherwise by their healthcare professional. Further, CDC recommends that moderately to severely immunocompromised people can receive an additional primary dose of the vaccine.

What We Know About Vaccine Breakthrough Infections

• Vaccine breakthrough infections are expected. COVID-19 vaccines are effective at preventing most infections. However, like other vaccines, they are not 100% effective.
• Fully vaccinated people with a vaccine breakthrough infection are less likely to develop serious illness than those who are unvaccinated and get COVID-19.
• Even when fully vaccinated people develop symptoms, they tend to be less severe symptoms than in unvaccinated people. This means they are much less likely to be hospitalized or die than people who are not vaccinated.
• People who get vaccine breakthrough infections can be contagious.

CDC is collecting data on vaccine breakthrough infections and is closely monitoring the safety and effectiveness of all Food and Drug Administration (FDA) approved and authorized COVID-19 vaccines.

Because vaccines are not 100% effective, as the number of people who are fully vaccinated goes up, the number of vaccine breakthrough infections will also increase. However, the risk of infection remains much higher for unvaccinated than vaccinated people.

The latest data on rates of COVID-19 cases, hospitalizations, and deaths by vaccination status are available from the CDC COVID Data Tracker.

Vaccine Breakthrough and Variants

CDC continues to actively monitor vaccine safety and effectiveness against new and emerging variants for all FDA-authorized COVID-19 vaccines. Research shows that the FDA-authorized vaccines offer protection against severe disease, hospitalization, and death against currently circulating variants in the United States. However, some people who are fully vaccinated will get COVID-19.

The Delta variant is more contagious than previous variants of the virus that causes COVID-19. However, studies so far indicate that the vaccines used in the United States work well against the Delta variant, particularly in preventing severe disease and hospitalization.

Overall, if there are more COVID-19 infections, there will be more vaccine breakthrough infections. However, the risk of infection, hospitalization, and death is much lower in vaccinated compared to unvaccinated people. Therefore, everyone ages 5 years and older should get vaccinated to protect themselves and those around them, including family members who are not able to be vaccinated from severe disease and death.

How CDC Monitors Breakthrough Infections

CDC has multiple surveillance systems and ongoing research studies to monitor the performance of vaccines in preventing infection, disease, hospitalization, and death. CDC also collects data on vaccine breakthrough infections through outbreak investigations.

About COVID-NET

One important system that CDC uses to track vaccine breakthrough infections is COVID-NET (The Coronavirus Disease 2019 [COVID-19]-Associated Hospitalization Surveillance Network). This system provides the most complete data on vaccine breakthroughs in the general population. COVID-NET is a population-based surveillance system that collects reports of lab-confirmed COVID-19 related hospitalizations in 99 countries, in 14 states.

COVID-NET covers approximately 10% of the US population. One recent COVID-NET publication assessed the effectiveness of COVID-19 vaccines in preventing hospitalization among adults 65 years and older. This system provides complete data on vaccine breakthrough hospitalizations in the general population.

Examples of CDC’s Systems for Monitoring:

Outcome Monitored	Population Monitored	Monitoring System
Infection	Long-term care facility residents	NHSN
Infection and symptomatic illness	Healthcare providers and frontline workers	HEROES/RECOVER
Hospitalizations and deaths	Hospitalized adults	IVY
Hospitalizations and deaths	Hospitalized people (all ages)	COVID-NET
Urgent care, emergency care, hospitalization, and deaths	Urgent Care, emergency departments, and hospitalized people (all ages)	VISION

Voluntary Reporting by State Health Departments

When the United States began widespread COVID-19 vaccinations, CDC put in place a system where state health departments could report COVID-19 vaccine breakthrough infections to CDC.

On May 1, 2021, after collecting data on thousands of vaccine breakthrough infections, CDC changed the focus of how it uses data from this reporting system.

• One of the strengths of this system is collecting data on severe cases of COVID-19 vaccine breakthrough infections since it is likely that most of these types of vaccine breakthrough cases seek medical care and are diagnosed and reported as a COVID-19 case.
• Persons with asymptomatic or mild cases of vaccine breakthrough infections may not seek testing or medical care and thus these types of vaccine breakthrough cases may be underrepresented in this system. For this reason, CDC relies on a variety of additional surveillance approaches to ensure that it is collecting information on all types of vaccine breakthrough cases.
• CDC continues to monitor data on all cases reported by the state health department as vaccine breakthrough cases. Currently, 49 states have reported at least one vaccine breakthrough infection to this system.

What You Need to Know

• If you’ve been fully vaccinated against COVID-19, you’ve taken the first step toward protecting yourself and your family and returning to many of the activities you did before the pandemic.
• To maximize protection from the Delta variant of the virus that causes COVID-19 and prevent possibly spreading it to others, wear a mask indoors in public if you are in an area of substantial or high transmission.
• Wearing a mask is most important if you have a weakened immune system or if, because of your age or an underlying medical condition, you are at increased risk for severe disease, or if someone in your household has a weakened immune system, is at increased risk for severe disease, or is unvaccinated. If this applies to your or your household, you might choose to wear a mask regardless of the level of transmission in your area.

How Can I Protect My Unvaccinated Family Members?

These are the best ways to protect your unvaccinated family members, including children who cannot get vaccinated yet:

• Get vaccinated yourself. COVID-19 vaccines reduce the risk of people getting COVID-19 and can also reduce the risk of spreading it.
• Be sure to get everyone in your family who is 5 years or older vaccinated against COVID-19.
• Wear a mask
  • To maximize protection from the Delta variant and prevent possible spreading it to others, have everyone in your family, even those who are vaccinated, wear a mask indoors in public if you are in an area of substantial or high transmission.
  • You might choose to have everyone in your family, even those who are vaccinated, wear a mask indoors in public regardless of the level of transmission in your area.
  • Unvaccinated family members, including children ages 2 years and older, should wear a mask in all indoor public settings.
    • To set an example, you also might choose to wear a mask.
    • Do NOT put a mask on children younger than 2 years old.

How Do I Protect A Family Member Who Has A Condition Or Is Taking Medications That Weaken Their Immune Systems?

• Get vaccinated yourself. COVID-19 vaccines reduce the risk of people getting COVID-19 and can also reduce the risk of spreading it.
• People who have a condition or are taking medications that weaken their immune system may NOT be protected, even if they are fully vaccinated. They should continue to take all precautions recommended for unvaccinated people, including wearing a well-fitted mask.
• If you live with someone who has a weakened immune system or is at increased risk for severe disease, you might choose to wear a mask in all indoor public settings regardless of the level of transmission in your area.

Choose Safer Activities For Your Family

• Outdoor activities are safer than indoor ones. If you are indoors, choose a location that is well ventilated, for example, a room with open windows, and know when to wear a mask.
• Avoid activities that make it hard to stay 6 feet away from others.
• If your family member is younger than 2 years old or cannot wear a mask, limit visits with people who are not vaccinated or whose vaccination status is unknown and keep distance between your child and other people in public.

Regardless of which safer activities your family chooses, remember to protect yourself and others. To learn more, visit

https://www.cdc.gov/coronavirus/2019-ncov/your-health/about-covid-19/caring-for-children/families.html

Your Guide to Masks

• Everyone 2 years of age or older who is not fully vaccinated should wear a mask in indoor public places.
• In general, you do not need to wear a mask in outdoor settings.
  • In areas with high numbers of COVID-19 cases, consider wearing a mask in crowded outdoor settings and for activities with close contact with others who are not fully vaccined.
• People who have a condition or are taking medications that weaken their immune system may not be fully protected even if they are fully vaccinated. They should continue to take all precautions recommended for unvaccinated people, including wearing a well-fitted mask, until advised otherwise by their healthcare provider.
• If you are fully vaccinated, to maximize protection from the Delta variant and prevent possible spreading to others, wear a mask indoors in public if you are in an area of substantial or high transmission.
• If you are fully vaccined, see ‘When You’ve Been Fully Vaccinated‘.

Wearing a mask over your nose and mouth is required on planes, buses, trains, and other forms of public transportation traveling into, within, or out of the United States and while indoors at US transportation hubs such as airports and train stations. Travelers are not required to wear a mask in outdoor areas of a conveyance (like on open deck areas of a ferry or the uncovered top deck of a bus.)

How to Select

Special Considerations

Mask Use & Carbon Dioxide

• Wearing a mask does not raise the carbon dioxide (CO2) level in the air you breathe.
• Cloth masks and surgical masks do not provide an airtight fit across the face. CO2 escapes into the air through the mask when you breathe out or talk. CO2 molecules are small enough to easily pass through mask material. In contrast, the respiratory droplets that carry the virus that causes COVID-19 are much larger than CO2, so they cannot pass as easily through a properly designed and properly worn mask.

How to Wear

How to Clean

Dry Your Mask

How to Store