What to Expect at our Facilities now that The PHE has ended on May 11, 2023
Based on current COVID-19 trends, the Department of Health and Human Services (HHS) has announced that the federal Public Health Emergency (PHE) for COVID-19, declared under Section 319 of the Public Health Service (PHS) Act, has expired at the end of the day on May 11, 2023.
With the expiration of the PHE, our facilities and communities will resume most pre-pandemic admission and care delivery processes. However, we will continue to align our Infection Control Practices (ICP) with current recommendations and guidance from the Centers for Disease Control and Prevention (CDC), and with any regulatory requirements from local and state health departments, the Department of Health and Human Services and the Centers for Medicare and Medicaid Services (CMS).
Therefore, our facilities and communities will continue to ensure that we comply with CDC guidance, as follows: (Please be aware that this is NOT an inclusive list). The complete guidance is found on this link – Infection Control: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) | CDC
a. Continue Staff and Patient Education – Encourage everyone to remain up to date with all recommended COVID-19 vaccine doses.
- HCP, patients, and visitors should be offered resources and counseled about the importance of receiving the COVID-19 vaccine.
- Please document in the clinical record that patient education was provided.
b. Staff Illness
Staff must be report/alert their supervisor if they are ill and are encouraged to stay at home. Please follow staff policies during an illness.
c. Establish a Process to Alert Staff and Visitors of IPC Practices in the Facility
- Ensure everyone is aware of recommended IPC practices in the facility.
- Post visual alerts (e.g., signs, posters) at the entrance and in strategic places (e.g., waiting areas, elevators, cafeterias). These alerts should include instructions about current IPC recommendations (e.g., when to use source control and perform hand hygiene). Dating these alerts can help ensure people know that they reflect current recommendations.
- Establish a process to make everyone entering the facility aware of recommended actions to prevent transmission to others.
(Please advise to defer non-urgent in-person visitation if they meet the following criteria:)
- a positive viral test for SARS-CoV-2
- symptoms of COVID-19, or
- close contact with someone with SARS-CoV-2 infection (for patients and visitors) or a higher-risk exposure (for healthcare personnel (HCP)
d. Implement Source Control Measures
Source control refers to use of respirators or well-fitting facemasks or cloth masks to cover a person’s mouth and nose to prevent spread of respiratory secretions when they are breathing, talking, sneezing, or coughing.
- People, particularly those at high risk for severe illness, should wear the most protective mask or respirator they can that fits well and that they will wear consistently.
- Even when a facility does not require masking for source control, it should allow individuals to use a mask or respirator based on personal preference, informed by their perceived level of risk for infection based on their recent activities and their potential for developing severe disease if they are exposed.
Source control options for HCP include:
- A NIOSH Approved ® particulate respirator with N95 ® filters or higher;
- A respirator approved under standards used in other countries that are similar to NIOSH Approved N95 filtering facepiece respirators (Note: These should not be used instead of a NIOSH Approved respirator when respiratory protection is indicated);
- A barrier face covering that meets ASTM F3502-21 requirements including Workplace Performance and Workplace Performance Plus masks; OR
- A well-fitting facemask.
- Recommended for individuals who have suspected or confirmed SARS-CoV-2 infection or other respiratory infection (e.g., those with runny nose, cough, sneeze); or
- Recommended for individuals who had close contact (patients and visitors) or a higher-risk exposure (HCP) with someone with SARS-CoV-2 infection, for 10 days after their exposure
- Source Control During an Outbreak – Must be used by those residing or working on a unit or area of the facility experiencing a SARS-CoV-2 or other outbreak of respiratory infection; universal use of source control could be discontinued as a mitigation measure once the outbreak is over (e.g., no new cases of SARS-CoV-2 infection have been identified for 14 days);
- Have otherwise had source control recommended by public health authorities (e.g., in guidance for the community when COVID-19 hospital admission levels are high)
- Facilities should consider several factors when determining how and when to implement broader mask use:
- The types of patients cared for in their facility.
- Facilities might tier their interventions based on the population they serve. For example, facilities might consider a lower threshold for action in areas of the facility primarily caring for patients at highest risk for severe outcomes (e.g.,cancer clinics, transplant units) or in areas more likely to provide care for patients with a respiratory infection (e.g., urgent care, emergency department). Except when experiencing an outbreak within the facility, facilities with patients or patients that generally do not leave the facility might consider implementing masking only for staff and visitors
- Input from stakeholders.
- Reviewing plans with stakeholders including patient and family groups and healthcare personnel can help a facility determine practices that will be more broadly supported.
- Plans from other facilities in the jurisdiction with whom the facility shares patients.
- Some jurisdictions might consider a coordinated approach for all facilities in the jurisdiction.
- What data are available to make decisions.
- Facilities and jurisdictions might have access to more granular data for their jurisdiction to help guide efforts locally
- The types of patients cared for in their facility.
e. Perform SARS-CoV-2 Viral Testing
- Anyone with even mild symptoms of COVID-19, regardless of vaccination status, should receive a viral test for SARS-CoV-2 as soon as possible.
- Asymptomatic patients with close contact with someone with SARS-CoV-2 infection should have a series of three viral tests for SARS-CoV-2 infection. Testing is recommended immediately (but not earlier than 24 hours after the exposure) and, if negative, again 48 hours after the first negative test and, if negative, again 48 hours after the second negative test. This will typically be at day 1 (where day of exposure is day 0), day 3, and day 5.
- Testing is generally not recommended for asymptomatic people who have recovered from SARS-CoV-2 infection in the prior 30 days.
- Testing should be considered for those who have recovered in the prior 31-90 days; however, an antigen test instead of a nucleic acid amplification test (NAAT) is recommended. This is because some people may remain NAAT positive but not be infectious during this period.
- In general, performance of pre-procedure or pre-admission testing is at the discretion of the facility.
- Performance of expanded screening testing of asymptomatic HCP without known exposures is at the discretion of the facility.
Further information for Oregon: Oregon Health Authority : COVID-19 : COVID-19 Updates : State of Oregon
Further information for Arizona: – ADHS – Healthcare Providers & Facilities – Guidance & Strategies (azdhs.gov)
Further information for Washington – SARS-CoV-2 Infection Prevention and Control in Healthcare Settings Toolkit (wa.gov)