Attn: Nursing Homes and Assisted Living Facilities
DHS Encourages Long-Term Care Facilities to Plan for Potential Outbreaks
The Division of Quality Assurance is sending this message as part of our commitment to Collaboration, Innovations, and Quality.
Wisconsin continues to see a high number of viruses circulating, including COVID-19, respiratory syncytial virus (RSV), influenza, and norovirus. With the increase in visitors normally seen during the holidays, DHS encourages Wisconsin Long-Term Care Facilities (LTCFs) to be prepared for potential outbreaks, which can arise and spread quickly in this population.
During this time of high viral activity, taking proactive steps to prepare for and manage outbreaks in your facility is critical. The following are considerations facilities can take to keep residents and staff safe and healthy.
Increase disease surveillance
Early identification of symptoms in residents, staff, and visitors will allow facilities to take appropriate actions in a timely manner and limit the spread of infectious disease. Residents who are experiencing symptoms should promptly be placed on transmission-based precautions while the infection is identified or ruled out. Residents in transmission-based precautions should be restricted to their room and be excluded from participating in group activities. Symptomatic staff should be excluded from work and follow facility employee health return to work policies. Ensure that staff who are not directly employed by the health care facility, but provide services, are also aware of the facility employee health policies. Visitors should be encouraged to stay home and not visit the facility while experiencing symptoms of any kind.
Perform testing as indicated
Facilities should have adequate testing supplies on hand and testing protocols in place. Staff should be educated on specimen collection techniques for different communicable diseases.
Continue to prioritize COVID-19 testing for staff and residents experiencing respiratory symptoms. If test results are negative for COVID-19, consider additional testing for other respiratory viruses with an acute respiratory illness (ARI) panel. Wisconsin LTCFs can contact their local or Tribal Health Department (LTHD) for approval to send 3-5 specimens to the Wisconsin State Laboratory of Hygiene (WSLH) for testing free of charge.
Testing for individuals experiencing symptoms consistent with gastrointestinal illness, such as norovirus, is also available through WSLH. Facilities are encouraged to work with their LTHD if outbreaks of any kind are suspected.
Early testing is important to identify the cause of the outbreak and provide appropriate therapeutics if appropriate.
Manage PPE supplies proactively
Facilities should have a sufficient quantity of personal protective equipment (PPE) on hand (including gowns, gloves, eye protection, masks, and N95 respirators) at all times to safely respond to an outbreak. Facilities should not rely on the LTHD or other local health care facilities to provide PPE if the LTCF is short on supply. Understanding your facility’s PPE burn rate, or the rate at which your facility uses PPE, can be helpful in ensuring you have enough PPE on hand. In the event of a surge in illnesses requiring PPE beyond the facility anticipated burn rate, governmental and non-profit entities may be approved for supplies from the DHS stockpile. More information about the stockpile can be found at: Health Emergency Preparedness and Response: Medical Stockpile | Wisconsin Department of Health Services.
As you wait for the infectious agent causing the outbreak to be identified, it’s recommended that health care personnel empirically follow the most stringent PPE guidelines to avoid exposure. This includes wearing gloves, gown, eye protection, and fit tested N95 respirator for suspected COVID-19. Once the infectious agent is identified, appropriate PPE for that agent should be used.
Hand Hygiene
Hand hygiene is a key step in infection prevention. See the section on hand hygiene in Healthcare-Associated Infections: Precautions | Wisconsin Department of Health Services. As a reminder, if a GI outbreak is suspected, use of soap and water for hand hygiene is recommended.
Stock up on other supplies
Facilities are encouraged to have adequate supplies of other products that may be needed during an outbreak available as well, including dedicated resident equipment, cleaning and disinfection products that are effective for the types of viruses circulating, alcohol-based hand sanitizer, and enough accessible trash cans to manage disposal of additional PPE.
Additional Resources
Wisconsin Department of Health Services Resources
For more information on preventing and controlling acute respiratory illness outbreaks in LTCFs, see Preventing and Controlling Respiratory Illness Outbreaks in Long-Term Care Facilities webpage, which replaces the DPH memo formerly distributed annually.
For recommendations and guidance on acute gastroenteritis outbreaks, refer to the DHS Prevention and Control Recommendations for Acute Gastroenteritis Outbreaks in Wisconsin Long-Term Care Facilities guidance document..
Centers for Disease Control and Prevention (CDC) Resources
Questions?
For questions and additional outbreak assistance, reach out to the HAI Prevention Program at DHSWIHAIPreventionProgram@dhs.wisconsin.gov or your Regional Infection Preventionist.
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