Sheepshead Nursing and Rehabilitation Center Pandemic Emergency Plan

   Introduction

Sheepshead Nursing and Rehabilitation Center shall maintain a Pandemic Emergency Plan (PEP). A pandemic is an outbreak of an infectious disease over an extensive geographical area. During a pandemic the facility may need to implement restricted visitation, manage a shortage of staff and/or personal protective equipment and more difficult issues that may threaten the facility’s ability to remain operational.

    Purpose
The PEP is designed to aid in the preparedness, response and recovery of pandemics in accordance with state and federal requirements.

   Relationship to the Emergency Management Plan
The PEP is intended to serve as a section of the facility’s overall Emergency Management Plan. The PEP plan may be activated when a Pandemic is declared by either NYSDOH or CMS or determined by the facility to initiate necessary infection prevention and control measures.

   Updates and Revisions
The PEP will be reviewed and updated when deemed necessary and at least annually.

   PEP Location
• The PEP plan shall be kept in the Emergency Management binder.
• The PEP plan will be posted on the facility’s website and will be made available immediately upon request in accordance with NYS regulations.

   Infection Prevention and Control Policies and Procedures
• The Infection Preventionist/Designee will obtain guidance from the NYSDOH and CMS on disease-specific response actions. The facility receives NYSDOH and CMS updates via the HCS and from the facility’s Nursing Home Association.
• The facility will develop, review, revise and enforce existing infection prevention and control, and reporting policies.

   Regulatory Reporting
• The facility will assure it meets all reporting requirements for suspected or confirmed communicable diseases as mandated under the New York State Sanitary Code (10 NYCRR 2.10 Part 2), as well as by 10 NYCRR 415.19.
• The facility will ensure that it has access to the Health Commerce System (HCS) and other required reporting systems.
• Adequate staff will be provided access to reporting systems and roles shall be assigned.
• The IP/Designee will report using HCS and NHSN or other method as per NYSDOH and/or CMS guidance.

   Staff Education
• The facility Infection Preventionist (IP)/Designee shall provide education on Infection Prevention and Control upon hiring of new staff, as well as ongoing education on an annual basis and as needed should the facility experience the outbreak of an infectious disease.
• The IP/Designee shall conduct annual competency-based education on hand hygiene and donning/doffing Personal Protective Equipment (PPE) at an appropriate level for staff.
• The IP/Designee shall provide in-service training for staff on Infection Prevention policies and procedures as needed for event of an infectious outbreak.

   Surveillance/Screening
• At daily morning meeting, the IDT team will identify any issues regarding infection control and prevention.
• Residents will be monitored daily or more frequently to identify symptoms associated with infectious agent.
• The facility will screen employees, visitors and vendors in accordance with NYDOH and or CMS regulations.
• Facility acquired infections will be tracked/reported by the Infection Preventionist/Designee.
• Sick calls will be monitored to identify any staff pattern or cluster of symptoms associated with infectious agent.

   Testing
• The facility will conduct staff testing, if indicated, in accordance with NYS regulations and/or physician recommendations for a given infectious agent.
• The facility will arrange for necessary laboratory testing for residents and staff as needed.
• The DNS/Designee will check daily for staff and resident testing results and take action in accordance with state and federal guidance.

   Signage
• The Infection Preventionist/Designee will ensure that NYDOH and CMS required signage is visible in designated areas.
• The Infection Preventionist/Designee will ensure that appropriate infection prevention and control signage is visible in highly visible areas.

   Social Distancing
• The facility will review/revise the policy on communal dining guidelines and recreational activities during a pandemic to ensure that social distancing is adhered to in accordance with NYSDOH and CMS guidance.
• Recreation activities will be individualized for each resident in the event of social distancing.
• The facility will post signage indicating directives for social distancing as per NYSDOH and CMS guidance.
• Residents and staff will be educated and monitored to maintain social distancing between peers.

   Environmental Controls
• The facility will conduct cleaning/decontamination in response to the infectious disease utilizing cleaning and disinfection product/agent specific to infectious disease/organism in accordance with any applicable state and federal guidance.
• The facility environmental coordinator shall follow all Department of Environmental Conservation (DEC) and DOH rules for the handling of contaminated waste.
• Areas for contaminated waste are clearly identified as per NYSDOH guidelines and in accordance with all regulations.
• Any staff involved in handling of contaminated product shall be trained in procedures prior to performing tasks and shall be given proper PPE.
• The facility will amend the policy and procedure on biohazardous wastes as needed related to any new infective agents.

   Quarantine of Units
• Units will be quarantined in accordance with NYSDOH and CMS guidance.
• Appropriate transmission-based precautions will be adhered to for pandemic infection.
• Appropriate signage shall be posted at on each residents’ door indicating the type of transmission-based precautions that are needed.

   Resident Cohorting
• Residents shall be isolated/cohorted based on their infection status in accordance with applicable NYSDOH and CMS guidance.
• The facility will dedicate a wing or group of rooms at the end of a unit in order to cohort residents as necessary.
• The cohort area will be clearly demarcated by usage of signs and other appropriate methods to prevent residents from entering area.
• Sharing of bathroom with residents outside the cohort will be discontinued.
• Appropriate transmission-based precautions will be adhered to for each of the cohort groups as stipulated by NYSDOH.
• Appropriate signage shall be posted at on each residents’ door indicating the type of transmission-based precautions that are needed.
• Staff will be educated on the specific requirements for each cohort group.
• The facility shall attempt to dedicate caregivers assigned to each cohort group and/or for staff to attend to residents in the same cohort before moving to another group.
• Residents that require transfer to another health care provider will have their cohort status communicated to provider and transporter.
• The Administrator/Designee will evaluate cohort needs and capabilities on a regular basis including the following, number of residents per cohort, facility layout and staffing. In the event the facility cannot manage cohorting effectively, the Administrator/Designee will attempt to increase resources and/or discharge residents to an appropriate setting. The Administrator/Designee will notify the regional DOH and local DOH for further assistance if the facility cannot set up cohort areas or can no longer sustain cohorting efforts.

   Resident and Family Education
• The Nursing Department/Designee will provide residents and representatives with education about the disease and the facility’s response strategy at a level appropriate to their interests and need for information.
• Residents will receive updated information on the infective agent, mode of transmission, requirements to minimize transmission, and all changes that will affect their daily routines. The facility may utilize the following but not limited to letters, phone, hotline, website, social media and face to face.

   Out on Pass
• Out on pass and appointments will be restricted and limited based on NYSDOH and CDC guidance.

   Visitation/Vendors
• The facility will implement visitation guidance from NYSDO and CMS.
• Visitors may be restricted and/or limited as indicated and in accordance with NYSDOH and CMS guidance.
• As appropriate, vendors will be directed to drop off needed supplies and deliveries in designated areas to limit movement in the facility and/or prevent entering the facility.
• Residents, representatives, visitors and vendors will be informed as to visitation restrictions, limitations and guidelines as regulatory changes are made.

   Communication
• The Nursing Department/designee will update by telephone, representatives of residents that are infected with the pandemic related infection at least once per day and upon a change in the resident’s condition.
• Required communication will be by electronic means and the facility will work to accommodate another method selected by a representative.
• Administration/designee will use a hotline message to notify residents and representatives once per week on the number of residents currently infected with the pandemic infections and resident that expired that were infected or resulted from the pandemic-related infection.
• including residents infected with the pandemic-related infection but who pass away for other reasons.
• The Social Services Department/Recreation Department will inform residents and their representative of the hotline number to receive pandemic related information.
• The facility will provide all residents with no cost, daily access to remote videoconference or equivalent communication methods with representatives. The Recreation Department/designee will assist residents as needed including scheduling calls and providing equipment such as tablets and internet access.

   PPE, Sanitizer and Disinfectants
• The facility shall maintain at least a two-month (60 day) supply of PPE or any superseding requirements under New York State Executive Orders and/or NYSDOH regulations governing PPE supply requirements executed during a specific disease outbreak or pandemic. In the absence of such guidance the facility with consult the CDC PPE burn rate calculator. Supplies to be maintained include but are not limited to:
o N95 respirators
o Face shield
o Eye protection
o Gowns/isolation gowns
o Gloves
o Masks
o Sanitizer and disinfectants (meeting EPA Guidance current at the time of the pandemic)

• Supply needs will be based on census, not capacity and will include considerations of space for storage.
• The facility has established par levels for PPE.
• The facility has established par levels for Environmental Protection Agency (EPA) approved environmental cleaning agents based on pandemic usage.
• The Central Supply Coordinator/Designee in coordination with the Director of Nursing, Infection Preventionist, Medical Director, Facilities Manager and other appropriate personnel will review and calculate daily usage/burn rate to ensure adequate PPE is maintained.
• The Central Supply Coordinator/Designee shall establish a schedule for ordering and delivery of supplies. Supply issues such as shortages shall be reported to the Administrator/Designee.
• The facility shall designate a location for the secure storage of supplies.
• The Central Supply Coordinator/Designee shall rotate supplies needed.
• The Central Supply Coordinator/Nursing Supervisor shall ensure adequate and available PPE is accessible on all shifts.
• Hand sanitizer will be available upon entrance to facility and according to NYSDOH and CMS guidance. Daily Housekeeping staff will ensure adequate hand sanitizer and refill as needed.
• The facility shall implement emergency resource management strategies in the event resources are unable to be obtained through regular procurement methods.

   Food, Water, Medication, Other Supplies
• The facility has emergency par levels for food, water medication and other supplies.
• The Administrator and appropriate Departments will review and revise as needed with vendors, the facility’s supply arrangements for water, food, medication and other supplies.
• The facility shall implement emergency resource management strategies in the event resources are unable to be obtained through regular procurement methods.

   Admissions/Readmissions
• The facility will assure hospitalized residents will be admitted or readmitted to such residential health care facility or alternate care site after treatment, in accordance with all applicable laws and regulations including but not limited to 10 NYCRR 415.3(i)(3)(iii), 415.19, and 415(i); and 42 CFR 483.15(e).
• The facility will preserve a resident’s place in a residential health care facility if such resident is hospitalized, in accordance with all applicable laws and regulations including but not limited to 18 NYCRR 505.9(d)(6) and 42 CFR 483.15(e).
• Prior to admission/readmission the DNS/Designee will review hospital records to determine resident needs and the facility’s ability to provide care including cohorting and treatment needs.
• The Admissions Department will maintain communication with hospitals and the Nursing Department to schedule admissions/readmissions.
• The facility will implement closing the facility to new admissions in accordance with any NYSDOH directives relating to disease transmission.

   Recovery/Return to Normal Operations
• The facility will adhere to directives as specified by, State and CMS guidance at the time of each specific infectious disease or pandemic event e.g., regarding how, when, which activities/procedures/restrictions may be eliminated, restored and the timing of when those changes may be executed.
• The facility will communicate any relevant activities regarding recovery/return to normal operations with staff and other relevant stakeholders.