BCD: Lessons Learned from early Infection Control and Response Visits (ICARs) with LTCF: Topic 1

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Healthcare-Associated Infections (HAI) Prevention Program

Early Infection Control Assessment and Response Visits:
Lessons Learned

Topic 1: Infection Prevention When Residents Leave Their 
Long-term Care Facility for Appointments

In early April 2020, the DPH Healthcare-Associated Infections (HAI) Prevention Program began performing telephone-based, COVID-19-focused infection control assessment and response visits (ICARs) with long-term care facilities (LTCF) around the state.

ICARs are educational discussions that cover a range of infection prevention and control topics that can impact the spread of COVID-19 within a facility. ICARs provide opportunities for questions and discussion, a review of policies and practices, and "just in time" education.

The HAI program and its partners in this effort, including the Superior Health Quality Alliance and local health departments, have conducted more than 165 ICARs to date.  

This "Early ICARs Lessons Learned" series of messages will highlight common recommendations and clarifications our team of infection preventionists are making during these calls, as they promote best practices and alignment with CDC and DHS guidance.

Infection Prevention When Residents Leave Their LTCF for Appointments

Unlike CDC guidance to place individuals being admitted or re-admitted to a LTCF in a separate observation area in the facility for a 14-day quarantine period, current residents of a LTCF who go off-site for an outpatient appointment such as hemodialysis or chemotherapy, do not need to be placed in a separate observation area or quarantined upon their return to the facility. The exception to this would be when there is a COVID-19 outbreak associated with the outside medical facility or dialysis center visited. In that situation, residents going to the affected facility should be in a 14-day quarantine upon their return, due to their possible exposure to COVID-19. 

If, in an effort to reduce the risk of introducing COVID-19 into their facility, a LTCF chooses to place residents who leave the facility for outpatient appointments into quarantine upon their return, presenters participating in the CDC Clinician Outreach and Communication Activity (COCA) call on June 16, 2020, recommended that several factors be considered:

  • The potential benefit of quarantine in this situation must be weighed against the disruption of removing a resident from their usual living arrangement.
  • Current residents who are leaving for outpatient appointments should not be placed in the same quarantine location as new admissions/readmissions, as this could put residents with off-site appointments/underlying conditions at higher risk of contracting COVID-19 .
  • Health care personnel caring for residents in 14-day quarantine/observation should use all recommended PPE, including a respirator (or facemask if a respirator is not available), gown, gloves, and eye protection (i.e., contact and droplet precautions, in addition to standard precautions).  

LTCFs should consider more frequent COVID-19 testing for residents who leave regularly for appointments. Residents who leave the LTCF for appointments should wear a face covering, preferably a surgical/procedure mask, practice good hand hygiene, and maintain social distancing as much as possible when away from the facility.  Facilities should also ensure that the driver of the vehicle transporting the resident to the appointment is screened, wears a mask, and has alcohol-based hand rub available. 

Note that the recommendations highlighted here do not replace the value of a facility having its own ICAR, or the need to stay current with CDC and DHS guidelines. ICARs are non-regulatory and complement infection control surveys, with a focus on education and infection prevention. 

To request an ICAR for your facility, email the HAI Prevention Program or call 608-267-7711.