The World Health Organization (WHO) has released interim guidance for long-term care facilities aimed at preventing coronavirus 2019 (COVID-19) from entering these facilities and containing further spreading if introduced, as well as preventing the spread of the infection outside of the facility.
“The people living in [long-term care facilities] are vulnerable populations who are at a higher risk for adverse outcome and for infection due to living in close proximity to others,” the report noted. “Thus, [long-term care facilities] must take special precautions to protect their residents, employees, and visitors.”
Long-term care facilities should delegate an infection prevention and control (IPC) focal point within the facility responsible for leading and coordinating all related activities. This focal points should ideally receive team-based support be advised by a multidisciplinary committee.
Per the WHO, the IPC focal point should provide all employees with COVID-19 infection prevention and control training, including hand hygiene and respiratory etiquette, as well as training for standard precautions, and COVID-19 transmission-based precautions. Additionally, the IPC focal point should conduct information sessions for residents of the facility; these sessions should provide information and updates on the virus, and detail how they can protect themselves from the virus.
The focal point should also regularly audit IPC practices across the facility, and increase facility-wide emphasis on both hand hygiene and respiratory etiquette by the staff through the provision of appropriate supplies and regular reminders. Moreover, the IPC focal point should provide annual influenza and pneumococcal conjugate vaccinations to employees and staff.
Facilities should also institute physical distancing among residents, visitors, and staff. Group activities that cannot ensure physical distancing should be canceled, meals should be staggered, and both residents and employees should avoid activities such as shaking hands, touching, and kissing.
Visitor access to facilities should be restricted in areas with documented cases of COVID-19. When visitors are allowed, all individuals should be screened for signs and symptoms of COVID-19 or significant COVID-19 risk. Visitors who pass screening should be admitted in a limited capacity and only on compassionate grounds. The WHO recommends against visitation for patients with suspected or confirmed COVID-19.
WHO guidance emphasizes that COVID-19 response in long-term care facilities should be focused on early recognition, isolation, care, and source control. Prospective surveillance for COVID-19 should be established among residents and staff, including the assessment of new residents’ health at the time of admission and practices such as temperature checks twice daily for all residents, and at the time of entry to the facility for staff. Employees who report fever or respiratory illnesses should be asked to stay at home.
Residents who are suspected to have, or who have been diagnosed with COVID-19 should be isolated and provided with a medical mask. Testing should be undertaken, and public health authorities notified, in the event of a positive. Employees should utilize contact and droplet precautions when caring for residents with COVID-19. The rooms of residents with or suspected of having COVID-19 should be clearly marked with IPC signs. Dedicating specific medical equipment for these patients can also help contain disease spread.
Patients with suspected or confirmed COVID-19 should not leave their rooms while ill. Patient transport should be restricted only to essential diagnostic or therapeutic tests, and all transport services should be made aware of the required precautions.
When treating patients with suspected or confirmed COVID-19, personal protective equipment (PPE) specific to contact and droplet precautions should be used, including medical masks, gloves, gowns, and eye protection. Cleaning staff and those handling soiled bedding or laundry should also wear PPE.
Hospital-grade agents for cleaning and disinfection are recommended for all horizontal and frequently touched surfaces. Surfaces should be cleaned with detergent, followed by a hospital-grade disinfectant, and then rinsed clean with water. Soiled linens should be machine washed in warm water between 140 and 194 degrees Fahrenheit.
The WHO added that while long-term care facilities must take special precautions to protect the health and safety of residents, employees, and visitors, these infection prevention and control efforts may negatively affect the mental health and well-being of both residents and staff.
Facility staff should also remain cognizant of the ways in which COVID-19 isolation procedures may negatively impact residents. Older residents, particularly those with cognitive decline or dementia or who are highly care-dependent, may experience increased anxiety, anger, and agitation and become withdrawn during the outbreak. Staff can mitigate these emotions by providing both practical and emotional support through family networks and healthcare providers.
To support healthcare providers and caregivers, facilities should make every effort to protect staff from physical and psychological stress, and supportively monitor staff well-being and allow for rest and recuperation options for healthcare providers as able.
Both mental and psychological support are key; staff need to ensure that safety measures are in place to prevent excessive worries or anxiety within the long-term care facilities.
The WHO will provide updated guidance as new information becomes available.
World Health Organization. Infection prevention and control guidance for long-term care facilities in the context of COVID-19 [published March 21, 2020]. World Health Organization. doi:WHO/2019-nCoV/IPC_long_term_care/2020.1