Thursday, December 10, 2020

DR EPIC Newsletter

For Arizona SNFs: Emergency Preparedness Infection Control


DR EPIC Website Up and Running

Please take a moment to check out our EPIC website! It is designed to serve as a resource for you in your infection control efforts. You will find a wealth of clinical and industrial hygiene resources as well as a library of EPIC educational videos.

Go to EPIC.DisasterReadyaz.org to explore these tools.


Learn More about Wellness Check Points in your Facility

In this EPIC video, industrial hygiene EPIC expert consultant Derrick Denis offers insight into the complexity of establishing wellness check point stations in your facility. Some of these considerations include, staffing, egress, temperature tools and record keeping. To learn more, watch the video here.

If you have further questions, contact the EPIC Helpline at 602-241-4644 or EPIC@azhca.org


TIPS & FACT SHEETS for Your Use

Survey TIP TOPICS Address Infection Control

The EPIC clinical team has developed a series of “Top Ten Survey Deficiency Tip Sheets” related to infection control issues impacting state surveys. Check out this month’s TIP TOPIC on social distancing.

This guide will provide you with examples of deficiencies cited and corrective actions/best practices to follow, along with resources to further explore. Issues with social distancing have been cited in multiple DHS surveys.

There is clearly a surveyor focus on providing required distance between residents in common dining areas, especially on dementia units. Stay tuned for more TIP TOPICS related to state survey citations!

Disposal of Contaminated Waste Water, Water Everywhere, but not a Drop to Drink

Water incursion in all its iterations (rain water leaks, fire sprinkler water release, domestic supply failure, sewage backflow, etc.) is the most common environmental issue facing buildings.

If you are not up to snuff on water incursion, prevention and emergency response, you are putting your occupants, staff and facility at undue risk. Get some training, and assemble a team of inside and outside professionals you can call when a flood event occurs. Make plans for partial of complete flood evacuations and practice them.

For more on water incursion prevention and response, see our EPIC Fact Sheet on Category 3 Water, or reach out to the EPIC Helpline at 602-241-4644 or email EPIC@azhca.org.


Be Aware of CMS Surveyor Guidance on Corona Virus and Infection Control

CMS routinely provides guidance, clarifications and instructions to State Survey Agencies and CMS Regional Offices and there have been several memos specifically relative to COVID-19.These memos represent official guidance for surveyors.


FREE Infection Control Technical Assistance: Complete these Assessments

An important component of the DR EPIC program is to identify infection control protocols and gaps that may exist. We are asking skilled nursing facilities to complete two assessments that surveyors use; one for regular surveys and one for focused infection control surveys.

We then evaluate this information and Dr. Buffy Lloyd Krejci, our infection control consultant, will offer a personal conference call with your facility Director of Nursing and infection preventionist. This time with Dr. Buffy will do a deep dive into your practices and you will receive technical assistance as needed.

We will also be able to identify best practices that can be shared. If you have been contacted by members of the EPIC team, please complete the assessments that were sent and return them. If you haven’t been contacted and would like to participate, please contact Kay Huff at khuff@azhca.org.

This is a free service as part of the grant and can also help assure you will be prepared for the infection control portion of your next state survey.


Meet Gil Damiani, DR EPIC Consultant

Gil Damiani is a retired Assistant Fire Chief from the City of Mesa (AZ), where he spent more than 30 years. He served in multiple capacities including the fire department’s Public Information Officer, Assistant Chief of Operations, Assistant Chief of Training and Emergency Medical Services, as well as the last five years of his career as the Emergency Management Coordinator for the City of Mesa.

Gil has been working with the Arizona Health Care Association since December of 2016 as a Disaster Ready consultant. He is currently a State Certified Adjunct Instructor for the Arizona Department of Emergency Management teaching courses on the Incident Command System across Arizona.

As a consultant to the Disaster Ready EPIC Program, Gil provides leadership and technical assistance in emergency preparedness. Also, you can email any emergency preparedness or infection control questions to the DR EPIC online Help Center at EPIC@azhca.org.

You can also call the DR EPIC phone Helpline at 602-241-4644 and we will assist you.


DR EPIC Helpline Question of the Week

If a patient in Maricopa County is in the general population unit of a healthcare center and tests positive for COVID should the patient be wearing full PPE when transferred from the general population to the COVID unit?

ANSWER:

The Maricopa County guidelines for residents who develop COVID-19 in the facility include: Encourage residents to remain in their room and restrict movement except for medically necessary purposes. If residents leave their room, residents should wear a surgical facemask, perform hand hygiene, limit their movement in the facility, and perform social distancing (stay at least 6 feet away from others).”

So, YES, at minimum a surgical facemask should be worn by the resident/patient.

Response provided Kay Huff, RN


Check out our DR EPIC Helpline!

To submit questions, email the DR EPIC online Help Center at EPIC@azhca.org. You can also call the DR EPIC phone Helpline at 602-241-4644 and we will assist you.

Questions? Contact EPIC@azhca.org | This program is funded by ADHS HPP

The Disaster Ready Emergency Preparedness Infection Control (DR EPIC) program provides education and technical assistance for skilled nursing providers throughout the state. Individual providers will need to exercise their independent discretion in how to apply this information and technical assistance to the unique operation of each facility. For that reason, a facility’s use of its professional judgment and due diligence in utilizing the program for infection control and risk management practices is solely within the facility’s control for which it is entirely responsible.

December 10, 2020

Archived Articles

Thursday, November 5, 2020
For Arizona SNFs Regarding Emergency Preparedness Infection Control

Learn More about Respirator and Mask Fit

Check out our DR EPIC “short topic” video about fitting respirators and masks here. We have received questions through the EPIC Helpline on this issue and hope you will take a moment to review this video, which offers important tips from our industrial hygiene EPIC consultant, Derrick A. Denis. If you have further questions, contact the EPIC Helpline at 602-241-4644 or email EPIC@azhca.org.

Fact Sheets for Your Use

Nuisance Birds

Birds you keep as pets and birds seeking refuge at your site can be lovely, but can also put your residents, your staff and your building structure at risk. From fire hazards to roof collapse and from diseases to unsightly messes, nuisance birds can drive you cuckoo. Integrate regular bird control measures into your pest management program. For more on prevention and response, see our EPIC Fact Sheet.

Personal Protective Equipment (PPE) Utilization

PPE utilization is a key component in infection control. There have been many concerns about over- utilization during the COVID-19 crisis, and every facility has been faced with increasing costs for PPE. Many lessons have been learned along the way and regulatory guidance has been provided. To learn more about considerations in PPE utilization, check out our EPIC Fact Sheet.

Additionally, here are more resources on PPE utilization:

There are tools from various entities for estimating burn (use) rate of personal protective equipment (PPE) based on historical usage or on use practices for PPE supplies.

Disposal of Contaminated Waste

The focus on facility sanitation and disposal of waste has become a primary concern for providers, and it has increasingly been cited in state surveys. Many facilities treat trash and linen as biohazardous for COVID-19. This is not necessary and could potentially cost facilities thousands of dollars. It is important that each facility develop policies and procedures consistent with this guidance. Learn more in this EPIC Fact Sheet.

FREE Infection Control Technical Assistance: Complete These Assessments

An important component of the DR EPIC program is to identify infection control protocols and gaps that may exist. We are asking skilled nursing facilities to complete two assessments that surveyors use; one for regular surveys and one for focused infection control surveys. We then evaluate this information and Dr. Buffy Lloyd Krejci, our infection control consultant, will offer a personal conference call with your facility’s Director of Nursing and infection preventionist. This time with Dr. Buffy will do a deep dive into your practices and you will receive technical assistance as needed. We will also be able to identify best practices that can be shared. If you have been contacted by members of the EPIC team, please complete the assessments that were sent and return them. If you haven’t been contacted and would like to participate, please contact Kay Huff at khuff@azhca.org. This is a free service as part of the grant and can also help ensure you will be prepared for the infection control portion of your next state survey.

Meet Dr. Buffy Lloyd-Krejci, DR EPIC Infection Control Expert

One of the key components of the Disaster Ready Emergency Preparedness and Infection Control (DR EPIC) program is a clinical focus on prevention strategies. Dr. Buffy Lloyd-Krejci is leading the charge on this effort and is offering SNFs her expertise and leadership as a consultant to the EPIC grant. To learn more about Buffy and her role, click here to view an introductory video. Buffy will be conducting outreach to facilities state-wide to offer support and solutions to your infection control challenges, so watch for her contact! Also, you can email any emergency preparedness or infection control questions to the DR EPIC online Help Center at EPIC@azhca.org. You can also call the DR EPIC phone Helpline at 602-241-4644 and we will assist you.

DR EPIC Helpline Question of the Week

If a dialysis resident has an outdoor visit, what type of PPE do they need to wear outdoors to the visit – reverse isolation? Mask, gloves, gown since they are in isolation in their room?

Answer:

Be sure to follow your current policy for residents who are quarantined with unknown COVID-19 status. For example, it is important to ask, “Are quarantined residents allowed to go outside for fresh air?” There is no need to wear gowns and gloves – only a face mask should be worn. It is also important to conduct hand hygiene and remain socially distanced. If outdoor visitation is allowed, it is imperative that the resident agrees to wear a face mask at all times. If they are unable to do so, then I suggest delaying the visit until they are cleared from quarantine.
Response provided Dr. Buffy Lloyd-Krejci, DR EPIC consultant

Check out our DR EPIC Helpline!

To submit questions, email the DR EPIC online Help Center at EPIC@azhca.org. You can also call the DR EPIC phone Helpline at 602-241-4644 and we will assist you.

Questions? Contact EPIC@azhca.org | This program is funded by ADHS HPP

The Disaster Ready Emergency Preparedness Infection Control (DR EPIC) program provides education and technical assistance for skilled nursing providers throughout the state. Individual providers will need to exercise their independent discretion in how to apply this information and technical assistance to the unique operation of each facility. For that reason, a facility’s use of its professional judgment and due diligence in utilizing the program for infection control and risk management practices is solely within the facility’s control for which it is entirely responsible.
November 5, 2020
Thursday, September 24, 2020

For Arizona SNFs Regarding Emergency Preparedness Infection Control

Overview of the Disaster Ready Emergency Preparedness & Infection Control (EPIC) Program

Hopefully, you received a letter announcing the new EPIC program. Just in case you missed it, here is a video introduction to it. Basically, it will consist of four major components, targeting skilled nursing throughout the state:

  1. Analysis of infection control trends identified in ADHS surveys and a deep dive into facility assessments and how they properly reflect infection control practices.
  2. Targeted evaluation of the value of NHICS and other tools as implemented during the COVID- 19 pandemic.
  3. Education and technical assistance with industrial hygiene and facility sanitation. We will also be developing a portfolio of online resources in all of these subject areas.
  4. Establishment of an EPIC Helpline (see below).

DR EPIC Helpline Established

EPIC@azhca.org or 602-241-4644

Do you have questions about infection control clinical or regulatory guidance? Or facility sanitation or industrial hygiene? Well, we’ve established an EPIC Online Help Center to answer those questions. If you have any questions about infection control you can email the EPIC online Help Center at EPIC@azhca.org. You can also call the DR EPIC phone Helpline at 602-241-4644 and we will assist you.

September is National Preparedness Month

National Preparedness Month is recognized each September to promote family and community disaster planning now and throughout the year. As we continue to respond to COVID-19, there is no better time to be involved and prepared. Check out our Disaster Ready website at www.disasterreadyaz.org for resources to guide you in your preparedness efforts.

Meet Derrick A. Denis, DR EPIC Industrial Hygiene Expert

One of the key objectives of the EPIC program is to provide facilities with support in infection control from an industrial hygiene perspective. We know that facility sanitation practices are essential in protecting residents from the transmission of COVID-19 and other infections. Derrick A. Denis CIAQP, CAC, CIEC, Vice President of Indoor Environmental Quality for Clark Seif Clark, Inc., has been engaged to assist our members in addressing these very concerns. Meet Derrick in this video profile. Derrick will assist in answering your EPIC HELPLINE questions, so bring them on!

We Need your Feedback on the Disaster Ready Program

Since 2011, AHCA has been funded by ADHS to assist skilled nursing facilities in Arizona to prepare, respond and recover from emergencies and disasters. To help evaluate this program, we are asking providers and appropriate staff to complete this short questionnaire to identify program strengths, gaps and opportunities for improvement. Please distribute this questionnaire to key people within your facility or organization who have participated in Disaster Ready training so they can answer some simple questions and provide us with valuable feedback. Please complete this by September 25, 2020, and contact Krysten Dobson, Disaster Ready Program Manager, at kdobson@azhca.org with any questions. Thank you for your support of the Disaster Ready program!

Legionella and Legionnaire’s Fact Sheet

Germs are everywhere – even in the water we drink. Water systems in skilled nursing facilities can be complex and underused. Managing the health of your water systems is critical to protecting the health of your occupants and staff. Legionellosis, like many other diseases, disproportionately affects the immunocompromised (e.g., the sick and aged). Make sure you establish a team to address Legionella in your facility planning on a recurring basis. For more on Legionella prevention and response, see our EPIC Fact Sheet on Legionnaire’s Disease, visit one of the other resources available through the EPIC program, or reach out to one of our EPIC consultants directly. To learn more, check out the fact sheet.

Information courtesy of Derrick A. Denis, EPIC consultant

Transmission-Based Precautions

  • Do you have the appropriate transmission-based precaution signage outside the resident room that is on isolation precautions? Does the signage indicate precaution type, i.e., droplet, contact, airborne?
  • Who is in charge of ensuring the isolation bin is always fully stocked?

Recommendations:

  • Ensure that the isolation bins are always fully stocked.
  • Consider utilizing signage that indicates the type of isolation and the PPE requirements.
  • Consider placing instructions for donning and doffing on resident room door. https://www.cdc.gov/hai/pdfs/ppe/ppe-sequence.pdf

Information courtesy of Buffy Lloyd-Krejci, EPIC consultant

Here is a recent question answered by the DR EPIC Helpline.

Q. Can you help clarify the 28-day isolation requirement from Maricopa County? When would the first day of the isolation begin?

A. The Maricopa County guidance states that if a facility has a resident that develops COVID-19 in the building (not admitted with and not acquired within the first 14 days after admission) the facility is required to use COVID-19 isolation precautions for all residents, until 28 days have passed with no new cases. Please see below:

“Isolation of residents without respiratory symptoms or laboratory-confirmed COVID-19 can be lifted after 28 days (2 maximum COVID-19 incubation periods) have passed with no new cases identified in the facility who might have been exposed in the facility (i.e., resident was in the facility at any point during the 14 days before they became symptomatic/were tested). This does not include those who were known to be positive upon admission.” Here is a link to this guidance.

Questions? Contact EPIC@azhca.org |This program is funded by ADHS HPP

The Disaster Ready Emergency Preparedness Infection Control (DR EPIC) program provides education and technical assistance for skilled nursing providers throughout the state. Individual providers will need to exercise their independent discretion in how to apply this information and technical assistance to the unique operation of each facility. For that reason, a facility’s use of its professional judgment and due diligence in utilizing the program for infection control and risk management practices is solely within the facility’s control for which it is entirely responsible.

September 24, 2020