By Rebecca Mayo, J.D.
CMS has issued several letters providing direct, actionable steps facilities and home health providers can take to mitigate the spread of the coronavirus.
No matter where patients are being treated, whether it be in a facility or a home health care setting, CMS is making sure health care providers know what steps to take to prevent or mitigate the spread of COVID-19. According to the Centers for Disease Control and Prevention (CDC), seniors are at greater risk, so CMS announced specific guidance for nursing homes and hospice care centers to protect vulnerable residents. CMS issued a total of six letters addressing infection control procedures, screening for emergency departments, and how to handle shortages in supplies, personal protective equipment (PPE) and respirators.
Respirators. Facemasks may be an acceptable temporary alternative to respirators, but respirators should be used for patients with known or suspected COVID-19 once the supply chain is restored. Available respirators and airborne infection isolations rooms should prioritized for procedures that are likely to generate respiratory aerosols. The FDA approved the CDC request for an emergency use authorization to allow health care personnel to use respirators approved by the National Institute for Occupational Safety and Health, in a health care setting during the COVID-19 outbreak (CMS Letter to State Survey Agency Directors, Ref: QSO-20-17-ALL, March 10, 2020).
EMTALA. Hospitals with emergency departments governed by the Emergency Medical Treatment and Labor Act (EMTALA) must conduct appropriate medical screening examination of all individuals come to the emergency department. If hospitals are concerned that they do not have the capability or space to isolate the influx of emergency department patients seeking testing and treatment for COVID-19, they may opt to set up alternative screening sites on the hospital campus, either outside the entrance to the emergency department or in another location. Also, hospitals and communities may set up screening at off-campus sites where the hospital and community officials may encourage the public to be screened for influenza-like illness. However, an emergency department may not direct a patient who has already arrived at the emergency department to an off-site location for screening (CMS Letter to State Survey Agency Directors, Ref: QSO-20-15-Hospital/CAH/EMTALA, March 9, 2020).
Dialysis facilities. During dialysis treatment, facilities should maintain at least 6 feet of separation between masked, symptomatic patients and other patients and stations, or be dialyzed in a separate room with the door closed. Staff caring for patients with undiagnosed respiratory infections should follow Standard, Contact, and Droplet Precautions with eye protection, which includes using isolation gowns, gloves, a facemask, and eye protection (CMS Letter to State Survey Agency Directors, Ref: QSO-20-19-ESRD, March 10, 2020).
Nursing homes. Facilities in counties or counties adjacent to other counties where a COVID-19 case has occurred should limit visitation and all other facilities not in those counties should discourage visitation. When possible, a designated visiting space should be created near the entrance of the facility, or visitors should be instructed to limit their movement within the facility to only the resident’s room they are visiting. Additionally, facilities should consider steps to limit who is entering the facility, such as having supply vendors drop supplies at a loading dock rather than bringing the supplies into the facility (CMS Letter to State Survey Agency Directors, Ref: QSO-20-14-NH, March 9, 2020).
Hospice care. Hospice patients and/or their families should carefully discuss care option with the hospice team to ensure goals and wishes of hospice patients are respected consistent with patient right requirements. Health care professionals entering the room or home of a patient suspected of COVID-19 exposure should adhere to Standard Precautions and use a facemask or respirator, gown, gloves, and eye protection (CMS Letter to State Survey Agency Directors, Ref: QSO-20-16-Hospice, March 9, 2020).
Home health agencies. COVID-19 patients with mild symptoms may be managed at home if they can adhere to isolation recommendations but potential risk to household members should be considered. If the patient needs to be transferred to a hospital, they should wear a facemask during transport. Health care providers entering the home should wear all recommended PPE, the number of providers present should be limited to essential personnel, and any supplies brought into, used, and removed form the home must be cleaned and disinfected. PPE should be put on outside of the home prior to entry in the home and should be removed after leaving the home in an outdoor trashcan (CMS Letter to State Survey Agency Directors, Ref: QSO-20-18-HHA, March 10, 2020).
MainStory: TopStory CAHNews EMTALANews ESRDNews HomeNews HospiceNews QualityNews SNFNews
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