BCD: Lessons Learned from Infection Control and Response Visits (ICARs) with LTCFs: Topic 6

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Healthcare-Associated Infections (HAI) Prevention Program

Infection Control Assessment and Response Visits:
Lessons Learned

Topic 6: Staying Safe in Break Rooms

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 (LTCFs) 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 have conducted more than 230 ICARs to date.  

This "Early ICAR 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.

Staying Safe in Break Rooms

Several COVID-19 outbreaks have occurred at health care facilities in Wisconsin and elsewhere in connection with break rooms, which are believed to be a source due to mask removal while eating and drinking, the room size, and the potential for interaction with unknown asymptomatic positive health care personnel (HCP).

Strategies to limit potential COVID exposure and transmission in the HCP break room include:

  • Physical layout
    • Rearrange the room to keep HCP at least six feet apart, including marking the spatial separation.
    • Change workflows to permit only 1-2 employees at a time in the room.
    • Switch the break area location to allow for use by more personnel while maintaining 6-foot distancing.
    • Clearly post signs that indicate the maximum number allowed in the room together.
    • Remove excess seating so that only the permissible number of HCP can be seated.
  • Hand hygiene should be performed with soap and water or alcohol-based hand rub:
    • On entrance to the break area.
    • Prior to removing a mask.
    • After mask removal just prior to eating or drinking, preferably with soap and water.
    • After re-donning contaminated mask.
    • Just prior to exit from break area.
  • Masks
    • HCP should wear a face mask when entering the break area and remove it only right before eating or drinking. This means the mask should remain on while food is heated or prepared.
    • If a facility is using masks conventionally, the face mask is discarded after removal. New, clean masks must be available in the break area for donning immediately after eating or drinking.
    • If a facility is extending use of masks:
      • Perform hand hygiene.
      • Remove the face mask and carefully fold it so that the outer surface is held inward and against itself to reduce contact with the outer surface during storage.
      • The folded mask should be placed in a clean sealable paper bag or breathable container that is labeled with the HCP’s name.
        • Clean unused paper bags should be available in the break room to promote this practice.
        • If masks are placed in a container, it must be cleaned and disinfected after each use.
      • Place stored face mask in a labeled bag or container in a designated storage area in the break room.
        • To minimize potential cross-contamination, store masks so that they do not touch each other and the person using the mask is clearly identified.
        • Storage containers (e.g., bags) should be disposed of or cleaned after each use.
      • Perform hand hygiene before eating or drinking, preferably with soap and water, and after touching or adjusting the mask if necessary for comfort or to maintain fit.
      • Avoid touching the inside of the mask. If inadvertent contact is made with the inside of the mask, discard it and perform hand hygiene as described above.
    • Immediately after eating or drinking, perform hand hygiene. Use a pair of clean, non-sterile gloves when donning a used mask. Inspect mask prior to re-donning and discard if soiled or damaged. Discard gloves after the mask is donned and any adjustments are made. Perform hand hygiene again.
  • Asymptomatic COVID-positive employees working due to crisis staffing shortages should have a separately designated break room, but otherwise, all other recommendations remain the same.
  • Cleaning and disinfection
    • Each staff member should be responsible for disinfecting their table space, chair, and food preparation area after each use.
    • Facilities should ensure each break area is cleaned at least once per shift, including the microwave, countertops, table top, chair seats and backs, and high-touch areas (e.g., door handles). Cleaning should be done on a schedule and assigned.
  • Routine documented audits should be done to ensure infection prevention practices occur as required and staff are re-educated as needed.

Note that the recommendations highlighted here do not replace the value of a facility having its own ICAR, or the need to stay current on 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.