Recommendations for long-term care facilities

1. Long-term care facilities should report any confirmed or suspected COVID-19 cases that occur in their facility. To report a confirmed or suspected COVID-19 case, please submit a REDCap High Risk Settings Report online or call our Call Center at 206-477-3977 (open daily from 8:00 a.m. to 7:00 p.m.).
2. Guidance on what to do if you discover a COVID-19 case in your facility, Washington State Department of Health
3. See the Long-term care facilities toolkit, with guidance for facilities that identify a positive COVID-19 case.
4. You can also see additional guidance on what to do if you discover a COVID-19 case in your facility from the Washington State Department of Health.
5. Notes:
• COVID-19-related deaths are reportable to Public Health.
• The current definition of a COVID-19 outbreak at a long-term care facility or supported living agency is: one facility-acquired COVID-19 positive infection in a resident or client.

1. Signs and Symptoms of COVID-19 in the Elderly, PHSKC
2. COVID Symptoms, CDC
3. COVID/Influenza Symptom Table, Washington State Department of Health
4. Symptom Monitoring Template

1. Test to Treat in Long-Term Care Facilities
2. Testing locations in King County:
   Free testing sites in King County are open to anyone regardless of immigration or insurance status. Priority testing is given to those with symptoms or immediate risk for COVID-19. Advance appointment recommended. Test results may take up to 72 hours and are not guaranteed.
3. Outbreak Testing:
   See the Long-term care facilities toolkit, with guidance for facilities that identify a positive COVID-19 case.
4. Test Kits:
   We encourage facilities to request COVID-19 test kits from their commercial lab, acute care partner or other vendors. If you have a contract with a commercial lab, but they are unable to provide test kits, you may order from the county on our resource page. Note, this resource provides only test kits and does not include a provider order for the lab test or a lab to process the specimen.
5. Physician orders:
   It is important to partner with individuals' primary care providers, another health system, or a contracted provider to obtain lab orders if your facility does not have a medical director. It is advised you make arrangements for provision of COVID-19 standing orders for all staff and residents as future testing will likely be an ongoing need for the foreseeable future. PHSKC is not currently providing full-facility standing orders.
6. Information on clinical specimens, CDC
7. Interpretation of Antigen tests, CDC

1. Infection Control Assessment and Response (ICAR):
   Effective infection control is critical to preventing communicable diseases and stopping the transmission of COVID-19 in your facility. King County has an Infection Preventionist (IP) who is available to consult with you about your facility's infection control practices. To request an ICAR, call our main line to speak with an investigator 206-296-4774.
• Washington State also offers non-regulatory ICARs. To request a visit see visit the WA State Dept. of Health Infection Control Assessment and Response Program page.
2. Healthcare-Associated Infections (HAI), WA State Dept. of Health.
3. Infection Prevention Resources for Healthcare Facilities, WA State Dept. of Health
4. Infection Control Resource, WA State Dept. of Health
5. Infection Control Resources, CDC
6. Infection Control Audit Tools:
   • PPE Donning and Doffing Audit, Univ. of North Carolina at Chapel Hill
   • Hand Hygiene Audit Tool, WA State Dept. of Health
   • Checklist for Terminal Cleaning, CDC
   • Environmental Cleaning Checklist, CDC

1. Disinfection and Sterilization Guidelines in Healthcare Settings, CDC
2. Environmental Infection Control Guidelines in Healthcare Settings, CDC
3. Approved Disinfectants, EPA

Appropriate PPE should be worn by all healthcare workers, residents and visitors (if tolerated) regardless of vaccination status.

1. How to request PPE from King County:
   To request PPE from Public Health, visit our emergency resource page. Upload the PPE request form, fill out the items you are requesting and email to the form to rcecc.logs@kingcounty.gov.
2. How to put on and remove PPE safely:
• Sequence for putting on Personal Protective Equipment (PPE), CDC
3. Strategies for optimizing PPE use
4. Transmission-based precaution signs:
• Aerosol Precautions, WA State Hospital Association 
• Quarantine Precautions, WA State Dept. of Health
5. WA State Dept. of Health PPE Chart
6. Fit testing resources:
• Companies providing fit-testing
7. Employer responsibilities related to PPE and respirators, WA State Dept. of Health and Labor & Industries

Please refer to the guidance below:

1. Admission Guidance, CDC
2. Admission Guidance, WA State Dept. of Health

1. Overall Safe Start visitation guidance, WA State Dept. of Social and Health Services
2. Outdoor Equipment Support, WA State Dept. of Social and Health Services
3. Visitor Log template, WA State Dept. of Health
4. Visitor signage, WA State Dept. of Health
5. Guidance for Daily COVID -19 Symptom Screening for Staff and Guests, WA State Dept. of Health
6. Guidance for outdoor visitation, WA State Dept. of Health

1. Healthcare Exposure Risk Assessment and Work Restrictions Guidance, CDC
2. Healthcare Worker Return to Work Guidance, CDC
3. Requesting Emergency Staffing Resources, WA State Dept. of Health
4. Resources and Support for Workers During COVID-19 Pamphlet, Public Health – Seattle & King County
5. Guidance for Daily COVID-19 Symptom Screening for Staff and Guests, WA State Dept. of Health
6. Workers right resources:
   1. Employee Rights FAQs, WA State Dept. of Health
   2. Novel Coronavirus Outbreak (COVID-19) Resources, WA State Dept. of Labor and Industries
   3. Information for Workers, WA State Dept. of Health

1. Healthcare Worker Exposure Risk Assessment and Work Restrictions Guidance, CDC
2. Resident/Client Risk Assessment Tool, WA State Dept. of Health
3. King County Contact Tracing
4. King County Isolation and Quarantine Order
5. Isolation and Quarantine, WA State Dept. of Health

Memos from the Centers for Medicare and Medicaid (CMS):

1. Nursing home visitation – COVID-19
2. COVID-19 NHSN Reporting Requirements for Nursing Homes
3. Guidance for Infection Control and Prevention of Coronavirus Disease 2019 (COVID-19) in Nursing Homes
4. COVID-19 Long-Term Care Facility Guidance

1. COVID-19 resources in multiple languages, Public Health - Seattle & King County
2. CDC Resources in Languages Other than English, CDC
3. Washington State Long-Term Care Ombudsman Program
• Hotline: 1-800-562-6028
• TTY Users: 1-800-737-7931

1. King County Equity and Social Justice
2. Health Equity Resource, CDC

1. Adult Family Home COVID-19 response
2. Overview of Long-Term Care response