On Monday, October 5th, the CDC posted an acknowledgment that under certain circumstances, people have become infected by small particles that can linger in the air in poorly ventilated spaces. According to the CDC, SARS-COV-2, the virus that causes COVID-19, is most frequently spread among people in close contact with one another, making nursing homes an ideal place for this virus to spread.
In light of this recent news of airborne transmission being a possibility, It is important to keep in mind the infection prevention precautions that have been in place since March are still the most effective way to decrease the spread:
- Wash hands often with soap and water.
- Avoid close contact with people who are sick.
- Keep a distance of at least six feet away from people.
- Wear a mask when around others.
- Clean and disinfect frequently touched objects and surfaces.
- Cover your mouth when you sneeze or cough.
- Stay home if you are not feeling well.
The CDC has provided restriction relaxation guidelines for nursing homes to consider before fully reopening. These paired with the above guidelines will hopefully slow the spread and keep residents safe.
- Case Status in Community: Use state-based criteria to determine the level of community transmission and to direct progression from phase to phase (i.e. decline in number of cases, hospitalizations, or deaths, with exception of temporary outliers.)
- Case Status in Nursing Home(s): Absence of any new nursing home onset of COVID-19 cases, meaning a resident or staff member acquiring COVID-19 from the nursing home.
- Adequate Staffing: Make sure there is no shortage of staff, and that there is a contingency plan in place, in case a staff member falls ill.
- Access to Adequate Testing: All facilities should have a testing plan based on contingencies from the CDC. At a minimum the plan should consist of:
- The capacity for all nursing home residents and staff to receive a single baseline COVID-19 test before relaxing restrictions.
- The capacity to test any resident or staff who has signs or symptoms of COVID-19.
- The capacity for all staff and residents to be tested upon identification of a single new case of COVID-19 in any of the staff or residents.
- The capacity for continuance of retesting if needed.
- The capacity for routine staff testing.
- Daily screening of all staff.
- The ability to perform diagnostic testing or an arrangement with laboratories to process the diagnostic tests for the SARS-COoV-2 virus.
- A procedure in place for addressing residents or staff that decline or are unable to test.
- A procedure in place for addressing residents and staff if someone were to test positive.
- Universal Source Control: Residents, visitors and staff must wear a cloth covering or facemask when they are around others. If a visitor is unable/unwilling to wear a face covering they are not allowed to enter the facility.
- Access to Proper Personal Protective Equipment (PPE) for Staff: Make sure all staff dons proper PPE at all times while working. The PPE should be provided to them.
- Local Hospital Capacity: Make sure the local hospital has capacity to accept transfers from nursing homes if needed.
If all of the above have been taken into consideration and you’re able to meet or exceed all expectations, then visitation can be considered. Visitation can be conducted through different means based on a facility’s structure and residents’ needs, such as in resident rooms, dedicated visitation spaces, outdoors, and for circumstances beyond compassionate care situations.
Regardless of how visits are conducted, there are certain core principles and best practices that reduce the risk of COVID-19 transmission:
Core Principles of COVID-19 Infection Prevention:
- Screening of anyone who enters the facility for signs and symptoms of COVID-19 (e.g., temperature checks, questions or observations about signs or symptoms), and denying entry of those with signs or symptoms.
- Hand hygiene (use of alcohol-based hand rub is preferred)
- Face covering or mask (covering mouth and nose)
- Social distancing, at least six feet between persons
- Instructional signage throughout the facility and proper visitor education on COVID19 signs and symptoms, infection control precautions, other applicable facility practices (e.g., use of face covering or mask, specified entries, exits and routes to designated areas, hand hygiene)
- Cleaning and disinfecting high frequency touched surfaces in the facility often, and the designated visitation areas after each visit
- Appropriate staff use of Personal Protective Equipment (PPE)
- Effective cohorting of residents (e.g., separate areas dedicated COVID-19 care)
- Resident and staff testing conducted as required at 42 CFR 483.80(h) (see QSO-20- 38-NH)
Despite extreme caution and diligence with all of the above guidelines, there is still the looming fact that COVID-19 can be airborne.
While this means of transmission appears uncommon it is possible. For airborne transmission to occur there needs to be the presence of an infectious person producing respiratory droplets for an extended time (>30 minutes to multiple hours) in an enclosed space. In this circumstance, despite social distancing of six feet or more, the virus can still spread. This raises concern for nursing homes, as all residents eat in the same meal area, and participate in the same daily activities together. Circumstances under which airborne transmission of SARS-CoV-2 appears to have occurred include:
- Enclosed spaces, within which an infectious person either exposed susceptible people at the same time, or to which susceptible people were exposed shortly after the infectious person had left the space.
- Prolonged exposure to respiratory particles, often generated with expiratory exertion (e.g., shouting, singing, exercising) that increased the concentration of suspended respiratory droplets in the air space.
- Inadequate ventilation or air handling that allowed a build-up of suspended small respiratory droplets and particle
Preventing the Spread of COVID-19 via Airborne Transmission
Existing interventions to prevent the spread of SARS-CoV-2 appear to be satisfactory when addressing transmission both through close contact and under the unique circumstances favorable to potential airborne transmission. Among these interventions, which include social distancing, use of masks in the community, hand hygiene, and surface cleaning and disinfection, ventilation and avoidance of crowded indoor spaces are especially relevant for enclosed spaces, where circumstances can increase the concentration of suspended small droplets and particles carrying the infectious virus.
Proper Ventilation is one of the best ways to prevent the airborne spread of COVID-19. Air cleaners and HVAC filters help reduce the chance of the air becoming contaminated with the virus.
To learn more: