Given the high risk of spread after COVID-19 enters a nursing home, facilities must act immediately to protect residents, families, and staff from serious illness and death, the Centers for Disease Control and Prevention (CDC) emphasizes.
Subtle signs and changes in nursing home residents may signal the early onset of COVID-19 infections, said Kara Jacobs Slifka, MD, a member of the CDC COVID-19 response team.
“You know your residents best,” she said in a CDC training video. “Noting even small changes in their appearance and behavior may indicate a new COVID-19 infection. Alerting staff and a supervisor may prevent many others from infection.”
New symptoms of dizziness, headaches, diarrhea — any changes could be a sign of an infection, the CDC advises.
With asymptomatic transmission and environmental contamination, it may be possible to get COVID-19 by touching surfaces or objects that the virus is on, “such as the resident’s bed or bedside table or things like doorknobs or blood pressure machines, and then touch your mouth, nose, and eyes,” Slifka said. “The earlier you can recognize sick residents, the faster you can prevent COVID-19 from spreading throughout the building.”
The most likely mode of entry of the coronavirus is through healthcare personnel and other staff, “some of which may not have symptoms,” she said. “It is for this reason that you wear your surgical mask at all times and not work when sick.”
The resident’s temperature should be taken every day, and even more often if you are concerned about an outbreak. “A temp of equal or more than 100 [degrees Fahrenheit], or multiple temps of 99 should trigger a warning that this resident may have COVID-19,” Slifka said.
Since sick residents can rapidly progress to severe illness, they should have vital signs monitored three times a day, including use of a blood oxygen oximeter.
Ask them to tell you if they feel ill and monitor for symptoms, such as new and different coughs and sore throat, she said. CDC recommendations to prevent COVID-19 spread in nursing homes include the following:1
Keep COVID-19 from entering your facility:
Restrict all visitors except for compassionate care situations (e.g., end-of-life).
Restrict all volunteers and nonessential healthcare personnel (HCP), including consultant services (e.g., barber, hairdresser).
Implement universal use of source control [i.e., masking] for everyone in the facility.
Actively screen anyone entering the building (HCP, ancillary staff, vendors, consultants) for fever and symptoms of COVID-19 before starting each shift; send ill personnel home. Sick leave policies should be flexible and nonpunitive.
Prevent spread of COVID-19:
Cancel all group activities and communal dining.
Enforce social distancing among residents.
Ensure all residents wear a cloth face covering for source control whenever they leave their room or are around others, including whenever they leave the facility for essential medical appointments. Ensure all HCP wear a facemask or cloth face covering for source control while in the facility. Cloth face coverings are not considered personal protective equipment (PPE) because their capability to protect HCP is unknown. Cloth face coverings should NOT be worn instead of a respirator or facemask if more than source control is required. This includes an N95 or higher-level respirator (or facemask if a respirator is not available), eye protection, gloves, and gown. HCP should be trained on PPE use, including putting it on and taking it off.
If COVID-19 is identified in the facility, restrict all residents to their rooms and have HCP wear all recommended PPE for care of all residents (regardless of symptoms) on the affected unit (or facility-wide, depending on the situation). This approach is recommended because of the high risk of unrecognized infection among residents. Recent experience suggests that a substantial proportion of residents could have COVID-19 without reporting symptoms or before symptoms develop.
When a case is identified, public health can help inform decisions about testing asymptomatic residents on the unit or in the facility. Designate a location to care for residents with suspected or confirmed COVID-19, separate from other residents.
Financial Disclosure: Peer Reviewer Patrick Joseph, MD, reports that he is a consultant for Genomic Health, Siemens, and CareDx. Senior Writer Gary Evans, Editor Jason Schneider, Executive Editor Shelly Morrow Mark, Nurse Planner Patti Grant, RN, BSN, MS, CIC, Editorial Group Manager Leslie Coplin, and Accreditations Director Amy M. Johnson, MSN, RN, CPN, report no consultant, stockholder, speaker’s bureau, research, or other financial relationships with companies having ties to this field of study.
