Visiting Restrictions Plus Testing and Response Strategy

Currently, Sunset Home is restricted to visitors during the COVID-19 Pandemic.  Until further advisement from the CDC, CMS, IDPH, and Adams County Health Department, no visitors may enter our building.  Window visits and video chats can be arranged by calling the facility at 217-223-2636.

In addition to the visiting restrictions, Sunset Home has also implemented the following Testing and Response Strategy:

Baseline Testing

• Baseline testing was completed upon identification of first positive case in the facility on May 9th.

Procedure

• Testing while not in an outbreak in regards to staff
  • Any staff with fever or symptoms of COVID-19 will be excluded from work and directed to be tested
  • Adams County Health Department will be notified that there is a staff member in need of being tested.
  • Staff member will be excluded from work until test results are in.
  • If test results are negative, ability to return to work will be based on CDC and/or IDPH return to work guidelines
• Testing while not in an outbreak in regards to residents
  • Residents will have vital signs and symptoms monitored every 8 hours
  • For any resident with fever or symptoms of COVID-19, their physician will be notified so that the resident can be evaluated.
  • Resident will be immediately placed in contact/droplet precautions until they are evaluated by physician or designee
  • Resident will be tested with order from physician and will remain in isolation until test results are back
  • If test results are negative resident will be removed from isolation

• In event of positive case or outbreak regarding resident or staff
  • Adams County Health Department and Illinois Department of Public Health will be notified immediately of a positive test. NHSN COVID-19 module reporting will be completed. This notification will be made by the Director of Nursing, Infection Preventionist, or Administrator.
  • All staff and residents will be tested after 1 confirmed case
    • If testing capacity is limited at minimum all residents on the unit where the positive case was identified will be tested. As well as any staff members that have worked that unit in the last 3 days.
  • If testing is widely available all residents will be tested weekly until the testing identifies no new cases of COVID-19 among residents or staff over at least 14 days since the most positive test result.
  • If testing is widely available all previously negative staff members will be tested at least weekly until the testing identifies no new cases of COVID-19 among residents or staff members over at least 14 days since the most positive result.
  • If testing capacity is limited repeat testing will be reserved for residents that leave the facility for outpatient procedures (e.g. dialysis), or have known exposure to the positive case (e.g., roommates of cases or those cared for by a known positive staff member
  • Total number of tests performed, positive and negative results will be reported to Adams County Health Department, Illinois Department of Public Health, and on the NHSN COVID-19 module.

• Consent and Orders for Testing
  • Orders for COVID-19 testing will be received from the Medical Director
  • Consent for testing will be obtained as follows:
    • A resident with a BIMS score of > or equal to 10 may consent to testing on their own
    • A resident with a BIMS score of <10, consent will be obtained from the resident’s power of attorney, guardian, or responsible party
      • Residents that refuse testing or ones whose representative refuses testing will be isolated for 14 days in droplet precautions.
    • Staff members will sign a written consent form for testing or give verbal consent to being tested
      • Testing is a condition of employment for staff.
        • Should a staff member refuse testing, they are voluntarily terminating their position at the facility.
        • New hires will be tested before they begin orientation. They will be asked to limit their contacts after testing until test results are in. Testing is a condition of employment. Should any potential new hire refuse testing, their job offer will be rescinded.
        • Any students completing clinical training in the building are required to be tested before beginning clinical training. Any student refusing testing will not be allowed to complete clinical training in the facility.

• Obtaining a Specimen for Testing
  • A nurse that has been trained in the appropriate procedure for collecting a specimen may do so. The training will be in the form of a skills check off. This training may be completed by a nurse that was previously trained by a nurse contact from the Adams County Health Department.
• Nasopharyngeal swab
  • Complete hand hygiene and don appropriate PPE including:
    • Gown
    • Gloves
    • Face shield or goggles
    • N95 respirator
  • Tilt person’s head back 70 degrees
  • Insert swab into nostril. (Swab should reach depth equal to distance from nostrils to outer opening of the ear.) Leave swab in place for several seconds to absorb secretions
  • Slowly remove swab while rotating it. (Swab both nostrils with the same swab)
  • Place tip of swab into sterile viral transport media tube and snap/cut off the applicator stick
  • Doff PPE, (if testing multiple residents when testing all residents in facility; remove gloves and complete hand hygiene before moving on to next resident. Use guidance on extended use of PPE if supplies are limited)
  • When finished with testing; Doff all PPE.
    • Use alcohol based hand rub on gloves
    • Untie and remove gown, rolling outward and discard
    • Remove face shield or goggles, do not touch the face when doing so
    • Remove mask or N95 by using the straps, discard do not touch the face
    • Remove gloves, discard
    • Complete hand hygiene
  • Nasal (Anterior Nasal) Specimen
    • Complete hand hygiene and don appropriate PPE including:
      • Gown
      • Gloves
      • Face shield or goggles
      • N95 respirator
    • Nasal sampling is less invasive and results in less patient discomfort than sampling from other upper respiratory anatomical sites.
    • A self-administered nasal swab is similar to a nasopharyngeal swab in detecting coronavirus. • Collection of nasal swab specimens is less technically complex, so can reduce the risk of the spread of infection to healthcare providers, by (1) reducing the duration of the procedure, and (2) allowing the patient to perform self-collection while under supervision.
    • It also lessens PPE utilization, given that the patient can perform self-collection under supervision (versus the health care provider performing the collection).
    • The procedure for nasal (anterior nasal) sampling is as follows:
      • Using a flocked or spun polyester swab, insert the swab at least 1 cm (0.5 inch) inside the nostril (naris) and firmly sample the nasal membrane by rotating the swab and leaving in place for 10 to 15 seconds.
      • Sample both nostrils with same swab.
    • When finished with testing, doff all PPE
      • Use alcohol based hand rub on gloves
      • Untie and remove gown, rolling outward and discard
      • Remove face shield or goggles, do not touch the face while doing so
      • Remove N95 by using the straps, discard, do not touch the face
      • Remove gloves, discard
      • Complete hand hygiene
    • Protective Practices for Healthcare Providers Performing Nasal (Anterior Nares) Specimen Collection
      • For healthcare providers collecting nasal (anterior nares) specimens, or within 6 feet of patients suspected to be infected with SARS-CoV-2:
        • Maintain proper infection control and use recommended personal protective equipment (PPE), which includes an N95 or higher-level respirator (or facemask if a respirator is not available), eye protection, gloves, and a gown, when collecting specimens.
      • For healthcare providers who are observing patient self-collection of nasal (anterior nares) samples, so are therefore handling specimens, but are not directly involved in collection and not working within 6 feet of the patient:
        • Follow Standard Precautions
        • Gloves are recommended. Note that healthcare personnel are recommended to wear a form of source control (facemask or cloth face covering) at all times while in the healthcare facility.
        • PPE use can be minimized through patient self-collection while the healthcare provider maintains at least 6 feet of separation.

• Testing Lab Coordination
  • Testing will be coordinated through the Adams County Health Department for a suspected resident or staff member. Specimens will be couriered to the Illinois Department of Public Health lab in Springfield, IL. Infection Preventionist or Director of Nursing will contact Adams County Health Department to obtain testing materials as needed.
  • Subsequent weekly testing after positive case is identified and initial full round of testing is completed will be handled through Quest Labs. Infection Preventionist or Director of Nursing will notify Quest Labs that equipment for testing is needed.