Infection Prevention and Control guidance for Long-Term Care Facilities in the context of COVID-19

Response 

The response to COVID-19 in LTCFs settings is based on early recognition, isolation, care, and source control (prevention of onward spread for an infected person). 

Early recognition 

Early identification, isolation and care of COVID-19 cases is essential to limit the spread of the disease in the LTCFs. 

Prospective surveillance for COVID-19 among residents and staff should be established: 

  • Assess health status of any new residents at admission to determine if the resident has signs of a respiratory illness including fever2 and cough or shortness of breath. 
  • Assess each resident twice daily for the development of a fever (≥38C), cough or shortness of breath. 
  • Immediately report residents with fever or respiratory symptoms to the IPC focal point and to clinical staff. 

Prospective surveillance for employees should be established: 

  • Ask employees to report and stay at home if they have fever or any respiratory illness. 
  • Follow up on employees with unexplained absences to determine their health status. 
  • Undertake temperature check for all employees at facility entrance. 
  • Immediately remove from service any employee who is visibly ill at work and refer them to their health care provider. 
  • Monitor employees and their contact with residents, especially those with COVID-19; use the WHO risk assessment tool to identify employees who have been at high risk of exposure to COVID-19. 

Prospective surveillance for visitors should be established: 

  • All visitors should be screened before being allowed to see residents, including for fever, respiratory illness and if they have had recent contact with someone infected with COVID-19. 
  • Visitors with fever or any respiratory illness should be denied access to the facility. 
  • Visitors with significant risk factors for COVID-19 (close contact to a confirmed case, recent travel to an area with community transmission [applies only to those areas that do not have current community transmission] should be denied access to the facility. 

Source control (care for the COVID-19 patient and prevention of onward transmission) 

If a resident is suspected to have, or is diagnosed with, COVID-19, the following steps should be taken: 

  • Notify local authorities about any suspected case and isolate residents with onset of respiratory symptoms. 
  • Place a medical mask on the resident and on others staying in the room. 
  • Ensure that the patient is tested for COVID-19 infection according to local surveillance policies and if the facility has the ability to safely collect a biological specimen for testing. 
  • Promptly notify the patient and appropriate public health authorities if the COVID-19 test is positive. 
  • WHO recommends that COVID-19 patients be cared for in a health facility, in particular patients with risk factors for severe disease which include age over 60 and those with underlying co-morbidities (see Clinical management of severe acute respiratory infection (SARI) when COVID-19 disease is suspected). A clinical assessment is required by a medical professional with respect to disease severity, for the potential patient transfer to an acute health facility. If this is not possible or indicated, confirmed patients can be isolated and cared for at the LTCF. 
  • Employees should use contact and droplet precautions (see below) when tending to the resident, entering the room, or when within 1 m of the resident. 
  • If possible, move the COVID-19 patient to a single room. 
  • If no single rooms are available, consider cohorting residents with suspected or confirmed COVID-19. 
    – Residents with suspected COVID-19 should be cohorted only with other residents with suspected COVID-19; they should not be cohorted with residents with confirmed COVID-19. 
    – Do not cohort suspected or confirmed patients next to immunocompromised residents. 
  • • Clearly sign the rooms by placing IPC signs, indicating droplet and contact precautions, at the entrance of the room.5 
  • • Dedicate specific medical equipment (e.g. thermometers, blood pressure cuff, pulse oximeter, etc.) for the use of medical professionals for resident(s) with suspected or confirmed COVID-19. 
  • Clean and disinfect equipment before re-use with another patient.6 
  • Restrict sharing of personal devices (mobility devices, books, electronic gadgets) with other residents.