COVID-19: Long-Term Care Facilities

• An outbreak in a long-term care facility is defined as 2 or more confirmed cases of COVID-19 infection in staff who were onsite at any time during their exposure or infectious period OR 1 or more facility-acquired case(s) of COVID-19 infection in a resident.
  
  
• Per Washington State law, long-term care facilities are required to report any COVID-19 outbreaks that occur in their facility. To report a confirmed or suspected COVID-19 outbreak, please submit a REDCap High Risk Settings Report online or call our Call Center at 206-477-3977 (open daily from 8:00 am to 7:00 pm).
  
  
• Note: COVID-19 related deaths are reportable to Public Health.

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. Testing locations in King County
   For free tests sites – click on the MAP and filter by "No Insurance Required"
   
   
2. Outbreak Testing
   Conduct outbreak testing as soon as possible, regardless of vaccination status. CDC recommends testing ALL staff and residents immediately and every 3-7 days until 14 days pass with no new COVID-19 cases identified. (See CDC's testing guidance.)
   
   
3. 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.
   
   
4. 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.
   
   
5. Information on clinical specimens, CDC
   
   
6. 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:
• Free fit-testing resources, WA State Dept. of Health
• Companies providing fit-testing
  
  

Quarantine is no longer recommended for residents who are being admitted to a post-acute care (LTCF’s) facility if they are fully vaccinated and have not had prolonged close contact with someone with SARS-CoV-2 infection in the prior 14 days.

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

1. Overall Safe Start visitation guidance:
• For Adult Family Homes, Assisted Living Facilities & Enhanced Services Facilities
• For Nursing Homes and Intermediate Care Facilities
  
  
2. Outdoor Equipment Support, WA State Dept. of Social and Health Services
   
   
3. Visitor Log template, WA State Dept. of Health
   
   
4. Guidance for Daily COVID -19 Symptom Screening for Staff and Guests, 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

• Adult Family Home COVID response
  
• Overview of Long Term Care response