As we continue to monitor both the state and federal responses to addressing the coronavirus (COVID-19), Medford Leas has implemented heightened precautionary measures to protect and ensure the health and wellness of our residents and employees. Our priority remains in keeping our community safe and well-informed while vigilantly minimizing the potential introduction and spread of the coronavirus. As this situation further develops, we will continue to provide updated communication on this website.
In an abundance of caution, Medford Leas is strictly adhering to the guidelines and recommendations from the Centers for Disease Control (CDC), state and local health agencies, as well as, implementing additional safeguards to best control and prevent the introduction and spread of the COVID-19 virus.
The following information and protocol apply to residents, staff and visitors of Medford Leas and remain in effect until further notice (additional information pertaining to residents and staff have been communicated internally).
Message to Medford Leas Community
From Jeremy Vickers, CEO (November 19, 2021)
I am writing to provide you with important updates regarding the COVID-19 pandemic.
CURRENT COVID-19 INFORMATION
Coronavirus Cases – We have two new active COVID-19 staff cases to report. Two rounds of tests of potentially affected residents and staff have been completed and all results are negative.
The grid below reflects the status of Medford Leas cases since the beginning of the pandemic in March 2020.
As a reminder, staff presenting cold-like symptoms, should stay home and call their supervisor.
Residents who are not feeling well should check in with the Wellness Center.
State and Burlington County Case Counts – COVID-19 rates throughout the state and within Burlington County are currently in a moderate to high transmission rate.
COVID Vaccine Mandate for all Medford Leas Staff – In advance of the upcoming CMS and OSHA mandates, Medford Leas required all staff to get fully vaccinated on or before November 15th. Staff were also allowed to apply for religious or health exemptions. At this time, only vaccinated staff are working on either campus and all unvaccinated staff have been placed on leave. As of December 15th, unvaccinated staff who were not granted religious or medical exemptions will be deemed to have resigned their positions. We continue to encourage all unvaccinated staff to get vaccinated and return to work.
COVID Vaccine Booster – We continue to receive information from the State indicating decreased effectiveness of the initial COVID vaccine series over time – especially among older adults (see below). Therefore, we are pleased to report that most of our residents have received a COVID booster at this time. Because staff are now eligible for boosters, we are encouraging them to consider boosters. We are working with Boyd’s Pharmacy to set up a staff booster clinic on Saturday, December 11th. Staff should be on the lookout for communication about how to preregister for this clinic.
Vaccination Rates – The latest Medford Leas vaccination rates are as are follows:
- Residents – 99+%
- Active Staff – 100%
Many locations offer the vaccine and/or the booster on a walk-in basis. If staff or residents have had a vaccination outside of Medford Leas, please advise Human Resources or the Wellness Center, respectfully.
**NEW** Woolman Visitation Rules – CMS has released new guidance for visitation for licensed nursing facilities (our John Woolman floor). Beginning Monday, November 22nd, visitors may visit Woolman without scheduling an appointment. There will be no restrictions on length of visits or number of visitors. However, visitors will still be required to sign in at reception and need to maintain social distancing. This new guidance does not impact our assisted living floors.
Assisted Living (Haddon, Estaugh and Rogers) Visitation – Visitation guidelines in AL have not changed and visitors continue to need an appointment. In a recent call with the NJ Department of Health, they indicated that it could be several weeks before updated guidance for AL visitation may be released. We will continue to update you should further guidance become available.
Volunteers – Our ability to welcome back our volunteers to Assisted Living remains dependent upon the New Jersey State transmission rate reducing to a low (green) level. As previously stated, the State is still in a moderate (orange) transmission level.
**NEW** Coffee Shop Update – We are delighted to announce that as of Monday, November 22nd, AL Residents may return to the Coffee Shop. Hours and guidelines for the Coffee Shop will be the same for AL and IL residents. Please see the attached flyer for details.
**NEW** Masks for Independent Living Residents – Effective tomorrow (Saturday, November 20th) Independent Living residents are no longer required to wear masks in either the Community Building on the Medford Campus, or the Community Center on the Lumberton Campus. All residents must continue to wear masks when in any of the Healthcare (AL & nursing) areas – including Woolman, Assisted Living, Pharmacy, Therapy, or Wellness.
**NEW** Visitors on Campus Grounds – Because it has been determined that rates of transmission of COVID are very low when outdoors, we will be re-open our campus grounds (trails, nature trails and paved walkways to outside visitors) effective tomorrow (Saturday, November 20th).
In closing, I send to you, your family and friends my wishes for the very best of health and happiness during the upcoming holiday season. At this time last year, we were largely staying home and not with families and friends in order to protect ourselves and others. We have certainly come a long way over this past year, and while I understand that everything is not yet how we would like it to be, we should all be grateful for how much we have all accomplished together since this time last year. Happy holidays!
*as of November 19, 2021, and subject to change.
ACCESS TO MEDFORD LEAS (MAIN CAMPUS)
- The only access point onto the Medford Campus will be via Route 70.
- New Freedom Road and Wilkins Station Road entrances will be closed.
- Upon entry from the Route 70, all persons will be screened by Medford Leas staff.
- In the case of a flooding event, we will move the entrance temporarily to the Wilkins Station entrance. If that occurs, we will notify residents and staff via the Medford Leas emergency alert system.
SCREENING: In accordance with CDC and local disease control guidelines, all employees, contractors, and visitors are screened upon driving onto the campus. Any outside visitors needing to enter the community building will be screened upon entrance. People who have signs or symptoms of a respiratory infection or recent international travel (within 14 days) will be restricted from entering.
New CDC Mask Guidance (as of 8/6/21) – Because of the resurgence in COVID cases, the CDC has updated its guidance to encourage vaccinated and unvaccinated people to wear masks again.
Mask Guidelines- Everyone (excluding Independent Living residents, as of 11/20/21) must wear face coverings in all indoor spaces, including the community buildings. We are keeping our dining venues open and urge all staff and residents wear masks when not seated at their tables.
Other than the dining rooms, food-related events (where staff/residents take off masks to eat) should not be held indoors. Furthermore, we continue to encourage all staff and residents to continue to wear masks when off campus – especially in crowded indoor locations.
Community Buildings – Also a reminder that our Medford Campus Community Buildings and Lumberton Campus Community Center remain open to residents and staff only. At this time, guests, family members and those who do not live or work at Medford Leas are not able to enter these buildings (except to check in for AL visits).
Coffee Shop Update – As of Monday, November 22, 2021, AL Residents may return to the Coffee Shop. Hours and guidelines for the Coffee Shop will be the same for AL and IL residents.
Masks for Independent Living Residents – Effective November 20, 2021, Independent Living residents are no longer required to wear masks in either the Community Building on the Medford Campus, or the Community Center on the Lumberton Campus. All residents must continue to wear masks when in any of the Healthcare (AL & nursing) areas – including Woolman, Assisted Living, Pharmacy, Therapy, or Wellness.
Visitors on Campus Grounds (including Campus Trails) – Effective November 20, 2021, because it has been determined that rates of transmission of COVID are very low when outdoors, we will be re-open our campus grounds (trails, nature trails and paved walkways to outside visitors)
Staff who work on the Lumberton Campus are screened on the Medford Campus prior to going to Lumberton.
As of May 21, 2021
Outdoor Visitation – Outdoor visitation is the preferred method of visitation, even when residents and visitors are fully vaccinated against COVID-19.
- Independent Living (IL) residents have many outdoor locations on either campus for outdoor visitations
- Assisted Living (AL) and nursing residents have several approved outdoor spaces available to them and are asked to reserve these spaces through the nursing staff
Indoor Visitation – We have indoor visitation in IL and healthcare rules are as follows:
Healthcare – An important reminder that all visitors to Assisted Living must make an appointment with the appropriate nursing floor before arriving for a visit. Visitors must check in at the Reception Desk prior to going to Assisted Living and a surgical mask must be worn in AL. If someone does not have a surgical mask, one will be provided at Reception.
There are four types of visitation permitted in AL & nursing:
- End of Life Visits – By appointment, in the resident’s room. Please make appointments with the appropriate nursing station.
- Compassionate Care Visits – By appointment, in the resident’s room. Please make appointments with the appropriate nursing station.
- Essential Caregiver Visits – Approved caregivers may visit, by appointment, in the resident’s room, when there have been no positive resident cases for 14 days. Please make appointments with the appropriate nursing station.
- Social Indoor Visitation – AL and nursing visitation with up to two visitors at a time, for up to two hours, in the resident’s room. Visitors must enter at the Community Building and sign-in at Reception where they will receive a visitor badge. Visitors must then proceed to the appropriate nurse’s station and check-in prior to going for their visit. For more information, please contact the appropriate nursing station. If vaccinated Residents in nursing and AL are visiting with those who are vaccinated then the resident and the visitor can take off their masks and do not have to social distance in the resident room only. We are waiting for guidance on how we will monitor visitor vaccination status–more information will follow.
Independent Living – Appointments are necessary for IL residents as well as family members and friends. CDC guidelines suggest that fully-vaccinated IL residents can visit with one another indoors, without masks, and within six-foot distances. The CDC has indicated that such individuals can similarly visit unvaccinated people from a single household if everyone in that household is at low risk of developing a severe case of COVID-19. This type visitation is allowed, but not recommended within Independent Living resident apartments.
Community Buildings: Visitors are not allowed in either campus community building.
A reminder that our Medford Campus Community Buildings and Lumberton Campus Community Center remain open to residents and staff only. At this time, guests, family members and those who do not live or work at Medford Leas are not able to enter these buildings (except to check in for AL visits.
PERSONAL HELPERS and/or CONTRACTORS:
- Any help that is not affiliated with Medford Leas, should be directed to go to the Front Desk entrance at the Community Center to be screened before commencing work.
- Examples include housekeepers, gardeners or other personal assistants.
ASSISTED LIVING & NURSING:
- Woolman Visitation Rules – As of 11/22/21: CMS has released new guidance for visitation for licensed nursing facilities (our John Woolman floor). Beginning Monday, November 22nd, visitors may visit Woolman without scheduling an appointment. There will be no restrictions on length of visits or number of visitors. However, visitors will still be required to sign in at reception and need to maintain social distancing. This new guidance does not impact our assisted living floors.
- The resident rooms on Woolman will be temporarily limited to single occupancy, and any potential admissions to our rehabilitation unit from the community will need to be approved by the Medical Director.
- Assisted Living Visitation – An important reminder that all visitors to Assisted Living must make an appointment with the appropriate nursing floor before arriving for a visit. We are pleased to have such interest in visitors returning, but we must all adhere to this procedure. Appointments are necessary for IL residents as well as family members and friends. Visitors must check in at the Reception Desk prior to going to Assisted Living and a surgical mask must be worn in AL. If someone does not have a surgical mask, one will be provided at Reception. We appreciate your help in keeping our AL residents safe! Assisted Living Volunteers – Our ability to welcome back our volunteers to Assisted Living remains dependent upon the determination of the State of New Jersey. Because the increasing case counts, we do not expect any changes in the foreseeable future. We understand the strong desire of residents to return to their volunteer work and as soon as the State eases their regulations, we will advise you.
As a result of the Executive Order by the Governor of New Jersey, Outdoor Visitation with Assisted Living & Skilled Nursing is now permitted.
GROUP MEETINGS & EVENTS
LOCAL GROUPS: Meetings for local community groups, such as SJ Camera Club, Berry Basket Quilters and others are cancelled until further notice.
SPECIAL EVENTS: All special events are cancelled until further notice.
RESIDENT GROUPS: MLRA Council will work collaboratively with Committee Sponsors and Chairs to cancel or reduce meetings and activities.
UPDATE: August 9, 2021
New CDC Mask Guidance (as of 8/9/21) – Because of the resurgence in COVID cases, the CDC has updated its guidance to encourage vaccinated and unvaccinated people to wear masks again.
Because of the surge of the Delta variant and in conformance with the new CDC recommendations, as of Monday August 9th, everyone (including IL residents) must wear face coverings in all indoor spaces, including the community buildings. We are keeping our dining venues open and urge all staff and residents wear masks when not seated at their tables.
Other than the dining rooms, food-related events (where staff/residents take off masks to eat) should not be held indoors. Furthermore, we continue to encourage all staff and residents to continue to wear masks when off campus – especially in crowded indoor locations.
Masks – As with all CDC guidance, it is only guidance. Because New Jersey still has mask laws, we must continue to wear masks indoors. It is more than likely, that the State will issue revised laws in lieu of the new CDC guidance, but we must wait for that to occur. In the meantime, all staff are reminded to continue to wear masks while working indoors, and residents need to continue to wear masks except in their own apartments.
Staff Mask Mandate – All staff will continue to be required to wear a mask while indoors at work.
In the interim, we continue to ask you to:
- Practice proper hand hygiene
- Wear facial coverings/masks indoors and consider two masks – especially if your mask does not fit snug to your face
- Maintain a minimum distance of 6 feet from other people in all public/private spaces
- Adhere to maximum room occupancies in all public spaces
Effective April 10, 2020, based on CDC recommendation, all residents and staff
are to wear cloth face covering in public settings and where social distancing measures are difficult to
maintain- for example, the Community Building, grocery stores and pharmacies. A cloth face covering
is not intended to protect the wearer, but it may prevent the spread of virus to others. This is especially
important if someone is infected, but does not have symptoms. Cloth face coverings, such as a
homemade mask, scarf, or bandana are recommended for this purpose, not surgical masks, as these
critical supplies are still in short supply and should be reserved for healthcare workers and other first
Most importantly, wearing a cloth mask in public does not replace social distancing, but is another tool
to reduce transmission. Below are two links which may be useful – including one from the Surgeon
General. New Jersey is now at a level of community transmission that warrants these extra measures.
This mainly pertains to our independent living residents who may need to travel off campus for various
Surgeon General- How to Make Your Own Face Covering
How to Make a No-Sew Mask
We have a number of residents, staff and members of the local community making cloth face masks.
These masks will first be distributed to our staff to protect residents. If we obtain enough donations,
we will also make these masks available to residents. Contact Jane Weston, at 609-654-3007 or
firstname.lastname@example.org if you would like to help make cloth masks.
The following links are to health and disease control organizations and agencies. Their websites will provide you with additional information pertaining to coronavirus (COVID-19).
- COVID TESTING INFORMATION (Burlington County, NJ)
- NJ COVID TRAVEL GUIDELINES & GENERAL INFORMATION
- CENTERS FOR DISEASE CONTROL (CDC)
- WORLD HEALTH ORGANIZATION (WHO)
- NEW JERSEY DEPARTMENT OF HEALTH
ADDITIONAL PRECAUTIONS (for Residents, Visitors & Staff)
All community members including residents, visitors and staff—please do NOT come to the Community Building or visit with other residents if:
You are not feeling well—especially if you have a fever, a cough or are experiencing difficulty breathing or have shortness of breath. Anyone experiencing these symptoms should call their healthcare professional and Resident Health.
You have been in close contact with anyone known to have COVID-19 or if you have recently traveled to an area experiencing a Coronavirus outbreak.
You or anyone in your household, within the last 14 days, were on a cruise ship that had known COVID-19.
Please refrain from inviting family members to join you for lunch or dinner.
For your own protection and the protection of your loved ones, now is the time to limit face-to-face visits and practice your connections through phone calls, emails, and texts.
Again, stay home when you are sick and call your healthcare provider.
PRECAUTIONS REMAIN THE SAME
- Wash your hands often with soap and water for at least 20 seconds, especially after going to the bathroom; before eating; and after blowing your nose, coughing, or sneezing.
- If soap and water are not readily available, use an alcohol-based hand sanitizer with at least 60% alcohol. Always wash hands with soap and water if hands are visibly dirty.
- Avoid touching your eyes, nose, and mouth.
- Cover your cough or sneeze with a tissue, then throw the tissue in the trash.
Stay home when you are sick. Consult your healthcare provider about your symptoms.
The health, wellness and safety of our community is our top priority. Furthermore, communication regarding our efforts to address the coronavirus is also critical during this time. However, we ask for your patience and understanding that this is a fluid situation, changing daily if not hourly.
We will regularly review the latest information from the CDC regarding COVID-19 and make plans for the upcoming month. Updated information will be shared as it becomes available.
RESPIRATORY OUTBREAK RESPONSE PLAN (listed below)
(Effective 9/9/2020, Manual(s): Infection Prevention & Control)
To download a PDF of this plan, please CLICK HERE.
Policy Statement: It is the policy of Medford Leas to prevent the spread of respiratory illness and actively perform surveillance to identify a residents and staff infected with viral respiratory illness. It is the health care team’s goal to prevent and control the spread of the highly contagious illness to residents, staff or visitors. Staff, residents (and/or responsible parties), county, state and federal officials will be informed about the existence of and infection control and preventative measures to reduce the spread of a viral respiratory illnesses, as required by current laws, rules and regulations.
Purpose of Policy: It is the purpose of the policy to facilitate early detection of respiratory outbreaks, stopping transmission through control measures, identification of agent responsible for outbreak and using appropriate treatments and infection control practices to minimize the spread of illness to residents and staff. An outbreak may be occurring if:
1. Several residents exhibit similar respiratory symptoms and are in the same room, the same wing of a floor or attended a common activity
2. Two or more residents develop respiratory illness within 72 hours of one another
3. There is an increase in employee absences with many staff reporting similar respiratory symptoms.
If respiratory illness is suspected, droplet precautions should be immediately implemented. If suspected tuberculosis infection, airborne precautions are to be implemented at once. If Influenza infection is suspected, droplet precautions should be implemented at once. If COVID-19 or other novel coronavirus is suspected, contract, droplet, and airborne precautions are to be implemented at once.
· Post signs to reinforce infection control measures including the need to adhere to isolations precautions and perform strict hand hygiene before entering and leaving resident rooms
· Notify other departments, such as Environmental Services, Therapy etc. (as appropriate)
· Notify Dining Services:
o Notify by calling x 3003 and ask for the supervisor on duty
o Notify supervisor of the type of isolation precautions
o Dining Services will prepare and deliver tray to the unit as normal. Nursing staff will deliver trays to resident room
o After meal is completed, nursing staff will place the tray from isolation room in a plastic trash bag and will then place the tray in the cart
A. Droplet Precautions are used for residents with known or suspected diagnosis of an infection spread through droplets in the air.
1. In addition to Standard Precautions, Droplet Precautions include:
a. Private room, if possible
i. Cohort with a resident who is not a high risk for infection
ii. Cohort with a resident who is compliant and cooperative with directions
b. Personal Protective Equipment (PPE) are made available
i. All personnel and visitors are to make use of the PPE necessary upon entering the room. PPE shall be stored at the entrance of the room
ii. Hand Hygiene: Staff and visitors should clean their hands before and after leaving the room
1. This also applies to the resident
2. Soap and alcohol-based hand rub (ABHR) will be available
iii. Gloves must be worn by staff upon entering the room and removed after leaving
iv. Gowns should be worn when providing direct care, anytime there is a possibility of contamination, and if a resident has a productive cough and unable to perform “cough etiquette”
v. Masks: Staff and visitors should wear a mask upon entering the room and remove after leaving. The resident should wear a mask when out of his or her room.
c. Environmental Services Staff along with Nursing Staff are responsible for setting up the isolation rooms.
i. Notify Central Supply to obtain appropriate isolation trash and linen bins and necessary PPE
ii. Set up carts with necessary PPE
iii. Provide hand soap and/or alcohol-based hand rub (ABHR) in bathroom
iv. Set up Linen containers (with blue/green bags). See Linen Management Policy.
v. Set up Trash containers
d. Avoid common use of equipment when possible. If equipment is brought into the room, it must be wiped down and dried with appropriate germicidal before taken out of the room.
e. Any linen, trash or specimens must be double bagged with appropriate bags will be picked up twice a day by Environmental Service Staff. Do not shake out/agitate linens. See Linen Management Policy.
f. The resident may shower, but it must be the last shower of the day, when scheduled in shower room on the unit or a shower in a semi-private room, so Housekeeping Staff can decontaminate the area.
g. The Physical Therapy appointment must be the last appointment of the day when scheduled in the community therapy area so the room can be disinfected directly after therapy. Treatment may also occur at the resident’s bedside.
B. Airborne Precautions
· Medford Leas does not have negative air pressure rooms available on campus and, therefore, does not have the capability to properly care for a resident requiring isolation due to airborne pathogens.
· If it is determined/ordered that a resident needs this type of isolation precaution, a nurse who is fitted for an N-95 mask will care for the resident until the resident is transferred to the hospital. If a fit-tested N-95 mask is not available, the best available mask shall be utilized. The nurse will also utilize other precautions per procedures and protocols (gown, gloves, etc.).
· Residents are not required to be transferred to hospital assuming: 1) the resident does not require a higher level of care and 2) the facility can adhere to the rest of the infection prevention and control practices recommended for caring for a resident with COVID-19 or other novel coronaviruses . Residents infected with COVID-19 may vary in severity from lack of symptoms to mild or severe symptoms or fatality. Initially, symptoms may be mild and not require transfer to a hospital as long as the facility can follow the infection prevention and control practices recommended by CDC.
· The resident may develop more severe symptoms and require transfer to a hospital for a higher level of care. Prior to transfer, emergency medical services and the receiving facility should be alerted to the resident’s diagnosis, and precautions to be taken including placing a facemask on the resident during transfer.
Please refer to “Isolation Precautions Quick Reference Guide” for detailed guidance.
Reporting of suspected or confirmed outbreak to Burlington County Health Department or NJ Department of Health. Upon notification, NJDOH will assign an “E” number to the outbreak, which should be used for all outbreak correspondence and any laboratory samples.
The LHD, in consultation with the NJDOH epidemiologist, shall lead the investigation by providing the facility with guidance, support and assistance. The LHD should consider making an on-site visit for initial evaluation and ongoing assessment. The facility shall follow the basic steps listed below.
Note: Steps may or may not occur simultaneously during the course of the investigation.
A. Confirm that an outbreak exists
B. Verify the diagnosis using clinical, epidemiological and lab test information, considering seasonal disease occurrence
C. Develop a case definition based on clinical and laboratory criteria
D. Perform active surveillance
E. Document cases in a line list
F. Contact tracing investigation
G. Identify and eliminate transmission sources when possible
H. Institute control measures, balancing infection control concerns with disruption of residents’ quality of life routines
I. Evaluate effectiveness of control measures and modify as needed
J. Summarize the investigation in a written report to communicate findings
3. Confirm that an outbreak exists
Gather information to confirm an outbreak is occurring within the facility; this would include initial information on the number of ill and well residents and staff.
Definition of a Respiratory Virus Outbreak in LTC Settings:
One laboratory-confirmed positive case (e.g., influenza, RSV, adenovirus, Covid-19) in a resident along with other cases of respiratory illnesses on the unit;
A sudden increase over the normal background rate of acute respiratory illness (ARI)* cases, with or without documented fever (temperature ≥ 100°F OR 2° above the established baseline for that resident).
*ARI includes any two of the following symptoms: fever, sore throat, cough, rhinorrhea, and nasal congestion in the absence of a known cause (e.g., seasonal allergies, COPD).
Note: Elderly or medically fragile persons may manifest atypical signs of respiratory virus infection and may not present with fever.
4.Verify the diagnosis
A. Determine the cause of acute respiratory illness based on the history, physical exam and/or laboratory findings of the resident or staff member. Diagnostic testing can aid clinical judgment and guide outbreak control decisions. Be alert for noninfectious causes of symptoms such as COPD exacerbations. Influenza infections are seasonal, with higher incidence from December through April. During these months, when signs and symptoms are clinically compatible, strongly consider influenza.
B. Regardless of laboratory findings, public health control measures still need to be implemented.
C. Obtain laboratory confirmation of the infecting organism by testing specimens from several residents or staff within 48-72 hours of illness onset. Rapid antigen viral testing, PCR and viral culture should be done by collecting two simultaneous swabs. Use one swab for on-site rapid testing (if available), and send the second swab to the laboratory for PCR or virus culture. Some laboratories perform a respiratory virus panel, which would also include results for influenza. Bacterial culture should be considered as well, particularly during an outbreak of pneumonia. Strictly follow the protocol entitled “Instructions for Collection, Testing, and Shipping of Respiratory Virus Specimens” since the techniques used for the collection and submission of specimens can influence the outcome of test results.
D. Lab testing in an outbreak setting may be done through the facility’s standard procedures or at the state Public Health and Environmental Laboratory (PHEL). The LHD or NJDOH epidemiologist can assist with facilitating laboratory testing and/or specimen transport. All specimens sent to PHEL must be pre-approved by NJDOH and properly labeled and packaged.
E. After a single laboratory-confirmed case of influenza, Covid-19, or other respiratory virus among residents has been identified, it is likely that subsequent cases of associated respiratory illness are also caused by the same organism; mixed outbreaks due to other respiratory pathogens may sometimes occur. Persons developing compatible symptoms should be tested for respiratory pathogens. Ideally, at least two laboratory-confirmed cases within an incubation period are needed to confirm an outbreak’s etiology. When necessary, collect additional specimens from newly ill cases. When fewer than two laboratory-confirmed cases are found, a probable infectious agent can be inferred through clinical signs and symptoms.
5. Develop a case definition
An outbreak case definition describes the criteria that an individual must meet to be counted as an outbreak case. This includes clinical signs & symptoms, physical location and specific time period. Every outbreak will have a unique outbreak case definition. The outbreak case definition will be developed by the local health department or NJ department of health epidemiologist with cooperation from the facility based on the current situation. The NJ department of health epidemiologist is available for consultation as needed. Two examples of case definitions for acute respiratory illness associated with a long-term care setting are shown below:
A. Residents or staff on XYZ Unit experiencing an illness that is characterized by fever and at least two of the following, on or after mm/dd/yy: rhinorrhea (runny nose), nasal congestion, sore throat, cough (productive or non-productive), change in appetite, change in mental status, headache, lethargy, myalgia, respiratory distress, dyspnea, shortness of breath, pleuritic chest pain, or radiographic evidence of a pulmonary infiltrate.
B. Laboratory evidence of a respiratory pathogen such as influenza in a resident or staff member of Unit XYZ on or after mm/dd/yy AND at least one symptom or sign compatible with respiratory infection (e.g., rhinitis, pharyngitis, laryngitis, cough or pneumonia).
6. Perform active surveillance
A. Seek out additional cases of respiratory illness among residents and staff. Be alert for new-onset illness among exposed persons, and review resident and staff histories to identify previous onsets of illness that may not have been correctly recognized as being part of the outbreak.
B. Use influenza, Covid-19, and other respiratory viral testing promptly in newly identified cases of respiratory illness so that infection control measures specific to respiratory outbreaks can be initiated to prevent spread (e.g., antiviral prophylaxis.)
C. Testing Procedures
1. Any resident with suspected signs or symptoms of respiratory disease shall, as soon as feasible, be tested for influenza and/or Covid-19 as applicable. The resident will remain on transmission-based precautions outlined in Section 1. Procedure of this plan while awaiting test results.
2. Testing for Covid-19 will be part of the contact tracing program. Any resident who is identified during a contact tracing investigation to have a risk for exposure will be tested as soon as feasible. Staff testing may also occur at the Medical Directors (or designee) discretion when staff are identified during contact tracing investigations to have had a possible exposure.
3. Residents who have tested positive will remain on transmission-based precautions for a minimum of 14 days from the date of their initial test collection. After 14 days a second test will be performed. The resident will remain on transmission-based precautions while test results are pending. If the test results are negative the transmission-based precautions may be discontinued. If the test remains positive the retesting procedure will repeat in another 7 days for a total of 21 days past the date of initial test collection.
4. Any staff members who have tested positive for Covid-19 either at Medford Leas or any other outside laboratory or testing center will be excluded from work for a minimum of 14 days from the date their positive test collection occurred. The employee may return to work once 14 days from the date of the positive test has passed as long as they have been free of any symptoms of respiratory illness for at least 72 hours.
5. Facility wide routine testing of staff and residents may be conducted as directed from the NJ DOH, CMS, or other governing agencies. When facility wide testing is instituted the testing is mandatory for all staff. Any staff member not tested may be excluded from work for until testing is completed. Staff members will be required to give authorization for release of their laboratory testing results to the Medical Director with the intent of informing the facility of need to institute infection control measures and/or contact tracing investigations. Facility wide routine testing will follow the schedule as listed below:
During an outbreak or when otherwise directed by the NJ DOH, CDC, or othering governing agency, active monitoring shall occur.
1. Active monitoring of residents should include at a minimum once per 12-hour nursing shift full set of vital signs and evaluation for presence of signs of symptoms of active respiratory illness.
2. Employees are instructed to perform self-monitoring for any signs and symptoms of respiratory illness and to report any noted signs symptoms to their supervisor and not report to work when ill.
3. Any employee on work exclusion due to testing positive for Covid-19 will be given a self-monitoring form to complete which includes self-evaluation of symptoms and twice per day body temperature readings.
4. Entrance screening is enacted during an outbreak of Covid-19 or when otherwise directed by the NJ DOH, CDC or other governing agency. This may include answering questions about sign or symptoms, exposure and taking of body temperatures. Any employee or visitor who has a temperature of greater than 99.9 F or answers in the positive to the presence of any signs or symptoms or exposure to Covid-19 or other respiratory illness infected persons will not be allowed entry to the facility. If the person is an employee their supervisor and the infection preventionist shall be notified and the employee is encouraged to contact their primary care practitioner and/or local testing center to be tested for Covid-19 or other respiratory illness as appliable. If the person is a visitor, they will be encouraged to contact their primary care practitioner. Any Medford Leas residents who present with positive signs or symptoms and/or a body temperature over 99.9 F will be asked to self-isolate as soon as possible and the Wellness Center/OAC will be notified immediately.
7. Document and count cases
A. The facility shall develop and maintain a line list. Starting and maintaining a line list helps track the progress of an outbreak. A sample line list for residents with acute respiratory illness may be found at http://nj.gov/health/forms/cds-11.dot. A separate line list for employee illness should also be maintained.
B. The local health department investigator shall review the line list frequently with the facility and the NJ department of health epidemiologist to assess the status of the outbreak, and make recommendations regarding control measures.
8. Identify and eliminate possible transmission sources
A. A floor plan may be used in conjunction with the line list to document the physical locations of case-patients and ill staff to identify possible transmission routes.
B. Exclude sick staff. Staff members who become sick with a fever and/or respiratory symptoms during their shift shall be sent home immediately.
C. Monitor personnel absenteeism. Monitor personnel absenteeism due to respiratory symptoms and exclude those with influenza-like symptoms from work until at least 24 hours after they no longer have a fever.4
D. Inform receiving facilities of the outbreak when transferring residents. Transfer notification applies to both ill residents and exposed well residents. If at all possible, limit transfers to medical necessity.
E. The facility, local health department and NJ DOH epidemiologist should collaborate to determine the outbreak source. Occasionally, even with thorough investigation, the source might not be identified.
9. Institute control measures
Control measures are the tools that can end the outbreak by halting transmission. The local health department, in consultation with the NJ DOH epidemiologist, shall provide recommendations and guidance to the facility regarding control measures. Control measures can negatively impact residents’ quality of life by restricting their lifestyle, and staffing limitations are difficult to implement. Nevertheless, the facility should make every effort to institute and maintain adequate control measures until the outbreak is declared over.
Basic control measures are listed below.
Cohort residents, staff, equipment and supplies according to the living/work area
· Identify three cohort groups: 1.) “Ill” 2.) “Exposed” (not ill, but potentially incubating) and 3.) “Not ill/not exposed” (new admissions/staff.)
· Restrict use of equipment and supplies to use within a specific area, and do not allow residents/staff from one cohort to mix with other cohorts. (For example, suspend community dining or recreational activities where ill and well would otherwise intermingle.)
· Close the facility to new admissions if the physical set-up does not allow for complete segregation between “not ill/not exposed” and “ill/exposed” cohorts.
· Symptomatic residents should remain in their assigned room as much as possible, including having their meals served in their rooms, until 24 hours after their fever and respiratory signs and symptoms have resolved.
· If resident movement or transport is necessary, have the resident wear a facemask (e.g., surgical or procedure mask), if possible.
· Staff assigned to affected unit(s) should not rotate to unaffected units until the LHD and regional epidemiologist have determined that the outbreak is under control. This restriction includes prohibiting staff from working on unaffected units after completing their usual shift on the affected unit(s).
· In the instances of staffing shortages staff may be pulled or shared between areas that do not have any Covid-19 positive or presumed positive residents. In addition, licensed nursing managerial staff and leadership staff are available to for relief as needed.
10. Provide in-service education to ALL staff on ALL shifts
· In addition to all direct caregivers employed by the facility, staff includes volunteers, private duty, contracted or agency personnel who perform housekeeping, recreational, laundry, dietary, social service, physical therapy and administrative activities.
· Education is mandatory for all shifts, even if a staff in-service program has been completed recently.
· Place major emphasis on meticulous hand hygiene since it is the most effective measure for preventing further spread. Provide information on the infecting organism and its transmission, standard and droplet precautions, and movement restriction.
· Contact the LHD for fact sheets or other pertinent educational materials.
11. Restrict visits from family, friends and volunteers as necessary
Visitors with respiratory symptoms should be encouraged to postpone their visit until their symptoms resolve. However, a family member determined to visit may do so under any circumstance. For such visitors, consider offering a surgical mask, and encourage them to limit their visit only to their respective family members and to minimize touching of residents and environmental surfaces.
12. Environmental Measures
· Use routine cleaning and disinfecting strategies during influenza season. Focus on cleaning frequently touched surfaces in common areas and resident rooms. Special handling of soiled linens and dietary trays is not necessary.
· Use of disinfectants registered by the U.S. Environmental Protection Agency (EPA) is recommended whenever these are available. Lists of all registered disinfectants can be found at http://www.epa.gov/oppad001/chemregindex.htm. Many, if not all, of these products indicate potency for several target pathogens on the label. There are approximately 400 registered disinfectants with human influenza A and/or B listed on the product label, and all will inactivate respiratory viruses when used according to manufacturer instructions.10
· Environmental Services staff should use appropriate personal protective equipment (PPE) (i.e., gloves) as needed when preparing disinfectant and cleaning solutions and when applying these solutions.
· Clean and disinfect surfaces that are touched routinely by hand (e.g., doorknobs, bed rails, bedside and over-bed tables, bathroom surfaces, safety/pull-up bars, television controls, call buttons) on a more frequent schedule than that used for large housekeeping surfaces.
· Follow manufacturer instructions for proper use of disinfectants, especially with regards to the proper concentration of product and the time the product should be in contact with the surface being disinfected.
· Consult medical equipment instructions for appropriate methods of cleaning and disinfection for these items, and consider using barrier coverings for equipment that may be hard to clean or has accessible electronic components.
· Clean large housekeeping surfaces (e.g., floors) in resident -care areas with detergent/disinfectants in accordance with manufacturer instructions on a regular basis as per facility policy (i.e., at least daily and terminally cleaned at patient discharge).
· Avoid large-surface cleaning methods that produce mists or aerosols or disperse dust in resident -care areas (e.g., use wet dusting techniques, wipe application of cleaning and/or disinfectant solutions).
· Detergent and water are adequate for cleaning surfaces in nonresident -care areas (e.g., administrative offices).
· Follow facility procedures to ensure the cleanliness of cleaning and/or disinfectant solutions, rinse water, mop heads, and cloths (e.g., separate buckets for solutions and rinse water, frequent exchanges of solutions, replacing soiled mops heads and cloths with clean items, using microfiber mopping methods).
· Avoid placing influenza patients in rooms with carpeting if possible; use vacuums equipped with HEPA filtration when vacuuming carpets in resident -care areas.
13. Evaluate the effectiveness of control measures and modify as needed
Generally, the outbreak is considered to be over when two incubation periods have passed without a new case being identified. Waiting two incubation periods allows for recognition of potential secondary case-patients that are still asymptomatic but in whom the disease may be incubating. For influenza, two incubation period is approximately one week.
· • If new cases are identified after control measures have been instituted for one incubation period, continue outbreak control measures in consultation with the facility administration, LHD and the regional epidemiologist. Evaluate and enforce adherence to infection control precautions by all staff, residents and visitors. Continue control measures until no new cases are identified for two incubation periods.
· • When no new cases are identified after two incubation periods, control measures may be relaxed. Continue active surveillance for new cases according to LHD recommendations.