Communicable Disease Testing

Policy:

The Facility shall conduct testing of residents and staff for the control or detection of communicable disease in the following situations:

1. The facility is experiencing an outbreak; or

2. The facility is directed by the Department or the certified local health department where the chance of transmission is high, including, but not limited to, regional outbreaks, pandemics or epidemics.

Staff Responsible:

Infection Control Committee Members

1. Administrator

2. Director of Nursing

3. Infection Preventionist - designated coordinator of the Infection Prevention and Control Program

4. Medical Director

5. Licensed Nurses as designated

General:

1. The facility will make arrangements with a testing laboratory to process any specimens collected and ensure that complete information is submitted with each specimen including: Name, Address, Date of Birth, Sex, Race and Ethnicity.

2. The facility will report to the Department or certified local health department the number of residents and staff tested, and the number of positive, negative and indeterminate cases as directed by the Department or certified local health department.

3. Testing conducted at nursing homes should be implemented in addition to recommended infection control measures and not supersede them.

COVID-19 Testing:

1. Facility will partner with a lab that has rapid turn-around times (less than 48 hours) for test results.

a. Name of lab utilized by this facility: _______________________________

b. If needed the IDPH Partner lab will be utilized.

c. Facility should reference the testing instructions provided with the testing supplies by the designated lab and ensure that licensed staff obtaining the test is competent in the specific test provided.

2. Consent forms will be obtained for all residents and staff prior to testing.

a. Verbal consent may be used for residents and will be documented in medical record. This consent will remain in place until testing is no longer required or until the resident or POA formally rescinds the consent.

b. Staff consent will include sharing test results with facility.

3. Trained licensed staff will be utilized to obtain the tests using contact/droplet precautions with eye protection.

4. Facility will work with their Medical Director to obtain orders for all residents and staff for testing.

5. Baseline or initial testing will be conducted on all residents, who haven’t tested positive in the last 8 weeks, and all staff, who haven’t tested positive in the last 8 weeks, in coordination with local health department.

a. If any staff refuses baseline testing they will be considered positive and excluded from work without pay for 10 days.

6. If baseline or initial testing shows no positive staff or residents, then follow-up weekly testing for residents and/or staff will be conducted upon guidance from state and local officials based on the prevalence of virus in the community.

a. Once baseline or initial testing is completed, all new hires will be tested before starting employment.

7. Residents and staff will be actively screened for fever and COVID-19 symptoms, regardless of testing.

8. Any resident who exhibits fever or COVID-19 symptoms will be tested for COVID-19.

a. This will include any resident who has tested positive previously, but has since recovered and begins to exhibit symptoms again.

9. Any staff that has a fever or exhibit symptoms will be tested. If staff refuses testing they will be considered positive and excluded from work without pay for at least 10 days past symptoms.

a. This will include any employee who has tested positive previously, but has since recovered and begins to exhibit symptoms again.

10. All residents and staff who have potentially been exposed will be tested if there is a new or confirmed case of COVID-19 in the building.

b. If testing on the same neighborhood is not possible, then testing will be limited to symptomatic residents and staff, along with residents who have known exposure, such as roommates of positive cases or those cared for by positive employee.

c. Any staff member that refuses testing being conducted in response to a new or confirmed case of COVID-19 will be excluded from work without pay for at least 10 days after last weekly testing completion.

11. After testing all residents and staff in response to a new case, follow-up testing to ensure transmission has been terminated will be done as follows:

a. Testing of any resident or staff that develops fever or COVID-19 symptoms.

b. Repeat testing of all previously negative residents weekly (every 3 - 7 days) until the testing identifies no new cases among residents or staff for at least 14 days since the most positive result.

i. If test capacity is limited, CDC suggests directing repeat rounds of testing to residents who leave and return or have known exposure.

d. Repeat testing of all previously negative staff weekly (every 3 - 7 days) until the testing identifies no new cases of COVID-19 among residents or staff for at least 14 days since the most recent positive result.

i. If testing capacity is limited, CDC suggests directing repeat staff testing to those staff that work at other facilities where there is known COVID-19 cases.

12. Residents who refuse any testing will be considered positive and placed on contact/droplet precautions with eye protection for at least 14 days or until weekly testing reveals no new cases.

13. Residents who test positive will be placed in private room, if possible, for at least 14 days, depending on symptoms, using full contact/droplet precautions with eye protection.

14. Any new admission or readmission will be placed on contact/droplet precautions with eye protection in designated area for at least 14 days, depending on symptoms and tested prior to moving off that area.

15. Once baseline or initial testing is completed in a building any outside vendor or HCP (Pharmacist, Registered Dietician, Hospice staff, Physician, NP/PA, student or trainee, volunteer, Consultant, etc.) that comes into the building will be screened upon entry and will also need to provide proof of negative COVID-19 dated on or after facility’s baseline or initial test. This requirement would not apply to those vendors, who are not directly involved in care and not exposed to infectious agents (delivery drivers, building maintenance workers, etc.) as determined by the Infection Control Committee.

Testing Staff and Residents Who Previously Tested Positive:

· Most individuals who recently recovered from COVID-19 are likely no longer infectious even if they continue to have a positive viral test (e.g., persistently or recurrently detectable viral RNA). When an individual has a positive test result <6 weeks after they met criteria for discontinuation of Transmission-Based Precautions or Home Isolation, it can be difficult to determine if they have been re-infected or if they still have detectable viral RNA from their previous infection.

· Residents and HCP who had a positive viral test in the past 6–8 weeks and are now asymptomatic may not need to be retested as part of facility-wide testing unless the facility is using a test-based strategy to determine if residents can discontinue isolation or HCP can return to work. Residents and HCP who had a positive viral test over 8 weeks ago should be retested as part of facility-wide testing, regardless of symptoms.

· Residents and HCP who had a positive viral test at any time and become symptomatic after recovering from the initial illness should be re-tested and placed back on the appropriate Transmission-Based Precautions or excluded from work, respectively.