COVID-19 Preparedness Plan 2023



Prepared by: The COVID-19 Response Coordinator & Planning Committee

  • Organization COVID-19 Response Coordinator
    • Jeffrey Hand, RN, Vice President of Clinical Services: The Avante Group
    • Contact: (352) 585-8413
    • Email: jhand@avantegroup.com
  • Planning Committee Members:
    • Executive Director
    • Director of Nursing
    • Medical Director
    • Infection Control Nurse/Safety Site Coordinator
    • Assistant Director of Nursing
    • Maintenance Services
    • Environmental Services
    • Dietary Services
    • Therapy
    • Pharmacy Services
    • Purchasing Agent
    • Facility Staff Representative
  • Local/Regional Planning Groups:
    • Florida Healthcare Association
    • Agency for Healthcare Administration
    • Department of Health
    • Centers for Disease Control
    • Local Emergency Operations Center

I. Person Assigned for Monitoring Public Health Advisories

Jeffrey Hand, RN, Corporate Director of Education: Avante Group
Contact: (352) 585-8413
Email: jhand@avantegroup.com

II. Facility System for Inter-facility transfers

In the event of a suspected COVID-19 or confirmed COVID-19 case that would require inter-facility transfer, the facility will:

  1. Notify the Response Coordinator of Suspected Case and interfacility transfer
  2. Notify the MD assigned to the resident and receive orders if applicable for inter-facility transfer, document notification
  3. Notify EMS of the Infected resident prior to transfer and document notification
  4. Notify the Department of Health of suspected case and document notification
  5. Notify the Resident’s Responsible Party of possible/confirmed case of COVID-19 and need to transfer to higher level of care, document Notification
  6. Notify the Agency for Health Care Administration of possible/confirmed case of COVID-19 and document notification.

III. Facility System for Monitoring/internally reviewing development of COVID-19 amount residents and healthcare personnel in the facility

  1. Monitoring residents for symptoms of COVID-19 every shift including SpO2 and temperature.
  2. Employees must notify their ED or DON of any signs or symptoms.
  3. Line listing of Residents with Respiratory Symptoms/vital signs and monitoring of resident status until symptoms resolve. Line Listing to be sent to the Corporate Director of Education for review.
  4. Line Listing of Employees sent home or on self-quarantine related to a positive screen. Line Listing to be sent to the Corporate Director of Education for review.

IV. Infection Control Policies Recommending Transmission-Based Precautions

  1. In general, for undiagnosed respiratory infection, Standard, Contact and Droplet Precautions with eye protection are recommended unless suspected diagnosis requires Airborne Precautions.
  2. For confirmed cases of COVID 19, Special Contact and Droplet Precautions will be utilized.
  3. Visitors and Vendors are permitted to access the facility after the completion of a “visitors screen”.
  4. Federal, State and Local Government agencies are permitted to access the facility after completion of a “Visitor Screen”.
  5. Refer to Facility’s Policy and Procedure on Infection Control Labeled “Appendix A”

V. Specific Infection Prevention and Control Guidance for healthcare facilities caring for residents with suspected or confirmed COVID-19

  1. Updated PPE recommendations for the care of patients with known or suspected COVID-19:
    1. Based on local and regional situational analysis of PPE supplies, facemasks are an acceptable alternative when the supply chain of respirators cannot meet the demand. During this time, available respirators should be prioritized for procedures that are likely to generate respiratory aerosols, which would pose the highest exposure risk to HCP.
      1. Facemasks protect the wearer from splashes and sprays.
      2. Respirators, which filter inspired air, offer respiratory protection.
    2. When the supply chain is restored, facilities with a respiratory protection program should return to use of respirators for patients with known or suspected COVID-19. Facilities that do not currently have a respiratory protection program, but care for patients infected with pathogens for which a respirator is recommended, should implement a respiratory protection program.
    3. Eye protection, gown, and gloves continue to be recommended.
      1. If there are shortages of gowns, they should be prioritized for aerosol-generating procedures, care activities where splashes and sprays are anticipated, and high-contact patient care activities that provide opportunities for transfer of pathogens to the hands and clothing of HCP.
  2. Included are considerations for designating entire units within the facility, with dedicated HCP, to care for known or suspected COVID-19 patients and options for extended use of respirators, facemasks, and eye protection on such units. Updated recommendations regarding the need for an airborne infection isolation room (AIIR).
    1. Patients with known or suspected COVID-19 should be cared for in accordance with CDC guidelines. Airborne Infection Isolation Rooms (AIIRs) should be reserved for patients undergoing aerosol-generating procedures.
  3. Updated information in the background is based on currently available information about COVID-19 and the current situation in the United States, which includes reports of cases of community transmission, infections identified in healthcare personnel (HCP), and shortages of facemasks, N95 filtering facepiece respirators (FFRs) (commonly known as N95 respirators), and gowns.
    1. Increased emphasis on early identification and implementation of source control (i.e., putting a face mask on patients presenting with symptoms of respiratory infection)

VI. Standards for the Appropriate Use of Facial Coverings for Infection Control

  1. Health care practitioners and health care providers may choose to require a patient to wear a facial covering only when the patient is in a common area of the health care setting and is exhibiting signs or symptoms of or has a diagnosed infectious disease that can be spread through droplet or airborne transmission.
  2. Health care practitioners and health care providers may choose to require a visitor to wear a facial covering only when the visitor is:
    1. Exhibiting signs or symptoms of or has a diagnosed infectious disease that can be spread through droplet or airborne transmission,
    2. In sterile areas of the health care setting or an area where sterile procedures are being performed,
    3. In an in-patient or clinical room with a patient who is exhibiting signs or symptoms of or has a diagnosed infectious disease that can be spread through droplet or airborne transmission, or
    4. Visiting a patient whose treating health care practitioner has diagnosed the patient with or confirmed a condition affecting the immune system in a manner that is known to increase the risk of transmission of an infection from employees without signs or symptoms of infection to a patient and whose treating practitioner has determined that the use of facial coverings is necessary for the patient's safety.
  3. Opt-Out Requirements are as follows:
    1. Pursuant to 59AER23-2(1), health care practitioners and health care providers who choose to require a facial covering for any patient must include in the policy a provision for the opting-out of wearing a facial covering. Such policy must be in accordance with the Florida Patient Bill of Rights and Responsibilities, section 381.026, F.S.
    2. Pursuant to 59AER23-2(2), health care practitioners and health care providers who choose to require a facial covering for any visitor must include in the policy a provision for the opting-out of wearing a facial covering if an alternative method of infection control or infectious disease prevention is available.
  4. Health care practitioners and health care providers must allow an employee to opt out of facial covering requirements unless an employee is:
    1. Conducting sterile procedures,
    2. Working in a sterile area,
    3. Working with a patient whose treating health care practitioner has diagnosed the patient with or confirmed a condition affecting the immune system in a manner that is known to increase the risk of transmission of an infection from employees without signs or symptoms of infection to a patient and whose treating practitioner has determined that the use of facial coverings is necessary for the patient's safety,
    4. With a patient on droplet or airborne isolation, or
    5. Engaging in non-clinical potentially hazardous activities that require facial coverings to prevent physical injury or harm in accordance with industry standards.

VII. Facility Communications

  1. Local Health Department Contact: ________________________________
  2. AHCA/State Health Department Contact: Kim Smoak 850-559-8273
  3. State Long-Term Care Professional Association: Florida Healthcare Association 850-224-3907
  4. Person assigned for Communications with Public Health Authorities during COVID-19 Outbreak: Coeleen Bender, RN, Vice President of Clinical Services (352) 697-3850
  5. Key Preparedness Contact points of contact during COVID-19 Outbreak: ED or DON
  6. Contact person for communications with staff, residents, and families: ED or DON
  7. Local EMS Contact: __________________________________________
  8. Local Hospital: ______________________________________________

VIII. Supplies and Resources

  1. Hand Hygiene Supplies: Alcohol-based hand sanitizer with 60-95% alcohol in resident rooms and common areas if available. Sinks are well-stocked with soap and paper towels for hand washing.
  2. Respiratory hygiene and cough etiquette: Tissues and facemasks will be available for facility personnel on an as-needed basis.
  3. Necessary Personal Protective Equipment (PPE) are available in areas where resident care is provided. A trash can is near the exit inside the resident room to make it easy for staff to discard PPE prior to exiting the Room or providing care for another resident in the same room.
  4. Supply of facemasks, respirations (if available), gowns, gloves, eye protection
  5. Environment cleaning and Disinfection: Make sure that EPA-registered hospital-grade disinfectants are available for frequent cleaning of high-touch surfaces and shared resident equipment.
  6. The Facility will communicate with the Purchasing agent on a daily basis to report supply needs. The facility will collaborate with the Local EOC for supplies in the event of a supply shortage or unable to receive from the distributor.

IX. Identification and Management of Ill Residents

  1. If the community transmission levels are high, source control is required.
  2. The facility has all new admissions test for COVID-19 upon admission and 48 hours after admissions.
  3. Respiratory infections are monitored on a facility line listing to monitor symptoms and resolution of symptoms. In addition, a staff line listing is maintained for staff that are positive screened to monitor facility status.
  4. For suspected cases/confirmed cases the COVID-19 response coordinator is contacted in addition to the Department of Health per CDC recommendations.
  5. During times of outbreak, social distancing is recommended, and residents/staff are educated to this process. If a hospital has a new positive case of COVID-19- the facility will ensure they review the admission for clinical appropriateness.
  6. In the event of respiratory illness, the facility will cohort residents with like symptoms and diagnosis when possible following CDC guidelines. If there is a concern of spread of infection, the facility will limit Healthcare workers to working on a designated unit to avoid any potential cross-contamination.

X. Considerations about visitors

  1. Residents and families are provided weekly updates on outbreak status.
  2. Visitation is allowed during outbreak status after passing a screening tool.
  3. Infection control education and personal protective equipment are provided to each visitor prior to visiting.
  4. The facility is offering virtual visitation to residents and families via skype, Facetime, Letters, cell phone, texts, etc. Resident care plans have been updated to reflect these types of virtual visitations.

XI. Occupational Health

  1. The facility follows the Handbook related to sick time policies and is allowing for Paid Time off to be utilized in the event of illness.
  2. Education has been provided to the Facility staff on Signs and symptoms of COVID-19 in addition to effective hand hygiene. Competencies have been completed with the floor staff. Temperatures are being taken for facility staff prior to starting any shift in the facility, and they are educated on reporting signs and symptoms that they are experiencing to their supervisor.
  3. Prior to beginning their shift, each employee is screened for signs and symptoms, temperature, and risk factors. If any of the screen is positive, they are sent home per CDC and DOH guidance.
  4. Contingency plans have been established for essential staff that need to work from home ensuring that they have adequate access and equipment to do so.

XII. Education and Training

  1. The facility has reinforced sick leave policies and reminded staff not to report to work when ill.
  2. The facility will designate an infection preventionist/safety site coordinator who will reinforce adherence to infection prevention and control measures, including hand hygiene and selection and use of personal protective equipment (PPE). The facility has completed hand hygiene competencies with their staff in addition to competencies on donning and doffing PPE.
  3. The facility has educated providers and consultants of the risk for exposure related to multi-facility visits.
  4. The facility completed education with residents and families above COVID-19, actions the facility is taking to protect them and their loved ones, including visitor restrictions and actions residents and families can take to protect themselves in the facility.
  5. The facility-designated person responsible for coordinating education and training on COVID-19 is Jeffrey Hand, RN, Corporate Director of Education (352) 585-8413.
  6. Language and reading-level appropriate materials have been identified to supplement and support education and training programs to HCP, residents, and family members of residents (e.g., available through state and federal public health agencies such and through professional organizations. Our Corporate Director of Education has been reviewing CDC, DOH, AHCA, and FHCA websites for updates pertaining to COVID-19.
  7. Plans and material developed for education and job-specific training of HCP which includes information on recommended infection control measures to prevent the spread of COVID-19, including: Signs and symptoms of respiratory illness, including COVID-19. How to monitor residents for signs and symptoms of respiratory illness. How to keep residents, visitors, and HCP safe by using correct infection control practices including proper hand hygiene and selection and use of PPE. Training should include return demonstrations to document competency. Staying home when ill. HCP sick leave policies and recommended actions for unprotected exposures (e.g., not using recommended PPE, an unrecognized infectious patient contact)
  8. The facility will utilize the abbreviated “Agency Training packet” to train facility staff that are brought in from outside sources to ensure appropriate education and training occurs.
  9. Information materials have been provided to the facility to post in Resident and non-resident areas to promote education related to COVID-19.

XIII. Surge Capacity

  1. The facility has identified the minimum staffing needs to meet residents' needs and has prioritized critical and non-essential services based on resident's health status, functional limitations, disabilities, and essential facility operations. The facility communicates staffing levels on a daily call with the corporate office as well as provide safe census numbers that the facility is able to staff to.
  2. Our COVID-19 Response Coordinator (Coeleen Bender, RN, Vice President of Clinical Services) completes an assessment of current staffing needs and health status of staff on an as-needed basis.
  3. Legal counsel and state health department contacts have been consulted to determine the applicability of declaring a facility “staffing crisis” and appropriate emergency staffing alternatives, consistent with state law.
  4. The staffing plan includes strategies for collaborating with local and regional planning and response groups to address widespread healthcare staffing shortages during a crisis.
  5. Facility has inventoried their current PPE supply and has estimated the quantity of items based on current resident census.
  6. The facility’s supply needs have been communicated to the Local EOC by each Facility Administrator.
  7. The Corporate Purchasing agent is in contact with multiple distributors obtaining supplies as an additional means of supply during this event.
  8. Education has been provided to facility staff on appropriate utilization of supplies and conservation of supplies based on resident need.
  9. Discussion of current supply status with the COVID-19 Response Coordinator on an as-needed basis.
  10. In the event of an increased need for postmortem care, the facility has obtained body bags until the funeral home is able to pick up the deceased body.
  11. The facility would designate an area that is blocked off from resident access to use as a temporary morgue.
  12. Local plans for expanding morgue capacity have been discussed with local and regional planning contacts.