Bureau of Veterans Homes
Infection Control Policy and Procedures
DATE OF ISSUE
27 MAR 2020
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POINT OF CONTACT
CHIEF NURSING OFFICER
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REVISED
DATE
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REVIEWED
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BVH Managing Visitor Access and Movement for End of Life Situations during COVID-19 within the Pennsylvania State Veterans Home (PVH)
POLICY: The Bureau of Veterans Homes (BVH) is responsible for ensuring the health & safety of our Veteran residents by enforcing the standards required to help each resident attain or maintain their highest level of well-being.
Considering the spread of COVID-19, BVH is restricting visitors to our PVH for reasonable clinical & safety reasons as per the guidance from the Center for Disease Control & Prevention (CDC), Center for Medicare & Medicaid Services (CMS), & Pennsylvania Department of Health (PADOH) to help control & prevent the spread of the virus. Restrictions are placed to prevent community-associated infection or communicable disease transmission to the resident &/or visitors to assist the community in limiting spread of the virus.
Nursing facilities nationwide have been advised to “restrict all visitation except for certain compassionate care situations, such as end of life situations” where it is essential for a resident’s emotional well-being & care. Being on Hospice is not an all-inclusive qualifier to participate in compassionate end of life visitation.
Visitation may be permitted for residents who are receiving compassionate/end of life care or other situations where it is essential for a resident’s emotional well-being & care. The facility will make efforts to allow for safe visitation for residents and will maintain the residents’ rights to access the Ombudsman program.
This guidance and procedures for visitation are in effect when the individual PVH is not in the reopening process. For visitation guidance while the PVH is in one of the reopening phases see the BVH and PVH reopening plans.
PROCEDURE:
1. All visitors will be screened for fever & symptoms of COVID-19 before entry into the facility using BVH’s screening process.
2. All visitors will sign in and provide contact information.
3. Visitors that do not demonstrate proper use of infection control techniques will be immediately escorted from the facility.
4. Visitation is permitted for Red, Yellow and Green Zone Resident Care Areas:
a. Universal Source Control will be followed while in the facility
5. Universal Source Control Guidelines:
a. Social distancing of at least 6 feet is maintained to the most practical extent;
b. Wearing facemasks or other cloth face coverings while in the facility;
c. Facemasks will be provided to those entering the facility as needed;
d. Applying alcohol-based hand rub (ABHR)/hand sanitizer upon entry into the building;
e. Performing appropriate hand hygiene as needed while in the facility; and
f. Encouraging residents to wear facemasks or other cloth face coverings as tolerated when out of their rooms
6. Visitors who are suspected or confirmed to have COVID-19 will be prohibited.
7. When possible, alternative mechanisms for resident-visitor interaction will be offered, such as telephone, Facebook, email, video-call applications on cell phones or tablets.
8. Visits will be scheduled, and the charge nurse or designee will evaluate the risk to the visitor (i.e., visitor might have underlying illness putting them at higher risk for COVID-19) & their ability to comply with precautions.
9. Designate a specific visitation space in a neutral zone, ensuring that visitors can access that area passing only through other neutral zones. Where possible, use a specified entrance and route for visitors.
10. Establish and maintain visitation spaces that provide clearly define six-foot distance between the resident and the visitor (s).
11. Prior to entering the facility and or resident room, all visitors will receive education and training by the charge nurse or designee on the following:
a. Performing hand hygiene correctly
b. Frequency of hand hygiene
c. Following respiratory hygiene & cough etiquette precautions while in the facility, especially common areas
d. Limiting the number of surfaces touched
e. Appropriate use of Personal Protective Equipment (PPE), including correct donning/doffing & disposal
f. Limiting physical contact with residents & others while in the facility
g. Practicing of social distances with no handshaking or hugging, & remaining 6 feet apart
h. Limiting visitation to the resident’s room
i. Restrictions to other locations within the facility
12. Visitors are not permitted to be present in the resident’s room during any specimen collection procedures or other aerosolizing procedures13. Visitors that are permitted in a Red or Yellow Zone care will be required to wear full PPE during the entire visit (hair & foot coverings, gowns, gloves, facemask and face shield or goggles); respirators are not required:
a. PPE will be provided by the facility and the visitor will be escorted to the resident’s room
b. A staff member will be present for the visitor’s donning & doffing
c. The resident will wear a cloth face covering as tolerated during the visit
d. Public restroom use is permitted as needed
e. Disposable containers will be provided for comfort refreshments
14. Visits to a resident’s room in a Green Zone care area:
a. Full PPE is not required & a cloth face covering instead of a facemask is acceptable
15. When the visitor is ready to leave, a designated staff person will be escort them to the facility exit and have the visitor will sign out.
16. After the visitor leaves, the room or visitation area will be disinfected with EPA-registered disinfectant between visits.
Definitions:
Face coverings: Are NOT PPE and should not be worn for the care or during visitation of residents with suspected or confirmed COVID-19
Face masks: Face masks are PPE and are often referred to as surgical masks or procedure masks. Use face masks according to product labeling and local, state, and federal requirements. FDA-cleared surgical masks are designed to protect against splashes and sprays and are prioritized for use when such exposures are anticipated, including surgical procedures. Face masks that are not regulated by FDA, such as some procedure masks, which are typically used for isolation purposes, may not provided protections against splashes and sprays.
Green Zone Care Area: A resident care area where residents have not been tested and is thought to be unexposed to COVID-19.
Red Zone Care Area: A resident care area where residents tested positive for COVID-19 and are still within the parameters for transmission-based precautions.
Respirator: A respirator is a personal protective device that is worn on the face, covers at least the nose and mouth, and is used to reduce the wearer’s risk of inhaling hazardous airborne particles (including dust particles and infectious agents), gases, or vapors. Respirators are certified by the CDC/NIOSH, including those intended for use in healthcare.
Source Control: Use of cloth face coverings or face masks to cover a person’s mouth and nose to prevent the spread of respiratory secretions when they are talking, sneezing, or coughing. Face masks and cloths face coverings should not be placed on children under age 2, anyone who has trouble breathing or anyone who is unconscious, incapacitated, or otherwise unable to remove the mask without assistance.
Yellow Zone Care Area: A resident care area where residents have been potentially exposed and tested negative for COVID-19 but remain asymptomatic within 14 days of possible exposure.
References:
(Page Updated Aug. 12, 2020)