Executive Order Removes Conflict with CDC and CMS Guidance for Long-Term Care Settings

Posted on May 12, 2021 by Kari Everson

The Centers for Disease Control and Prevention (CDC) and the Center for Medicare and Medicaid Services (CMS) published updated infection prevention and control recommendations in response to COVID-19 vaccinations, QSO 20-38, and QSO 20-39 at the end of April. Immediately after these guidance documents were posted, the Minnesota Department of Health (MDH) directed nursing homes to pause before following the staff PPE and dining and activities portions of the recommendations due to potential conflicts with Gov. Walz's executive order.

A new executive order, 21-21, was published on May 6 that eliminates the conflicts for long-term care settings. As of May 7, all long-term care settings should follow the updated CDC and CMS recommendations.

Testing
Vaccinated staff no longer require routine surveillance testing based upon county positivity rate in nursing homes. There are some instances where fully vaccinated staff do need to continue to test, including the outbreak testing, if the employee is symptomatic, or if the employee has a high-risk exposure. Unvaccinated staff are still required to complete routine testing with frequency based upon the county positivity rate. The county positivity rates and testing frequencies have not changed from previous practice. This is a significant change in testing protocols within nursing homes.

• Testing Staff and Residents after High-Risk Exposure: Staff who experience a high-risk exposure and residents with prolonged close contact with someone with COVID-19 infection, regardless of vaccination status, should have a series of two viral tests. The first test should be immediately after the exposure is known and again 5-7 days after exposure.
• Testing & Symptomatic Individuals: Anyone, staff or resident, who is symptomatic should be quarantined and tested regardless of vaccination status.
• Testing & COVID + in the Last 90-days: Anyone, staff or resident, who has had COVID-19 in the last 90 days does not require testing if they are asymptomatic, including those with known contact with a COVID positive person. This can easily be confused with fully vaccinated persons, so to review: fully vaccinated persons do need to test during outbreak testing, but individuals who have been COVID-19 positive in the last 90-days do not need to participate in outbreak testing.

PPE
While working in resident care areas, staff should continue to wear PPE, including gloves, masks and eye protection, plus gowns in isolation and quarantine areas. However, there is an exception to the staff PPE rule for fully vaccinated healthcare workers in non-resident care areas. Fully vaccinated staff can be together in non-resident care areas such as breakrooms or meeting rooms where they can eat together and have in-person meetings without source control (masks) or physical distancing. This changes if there is an unvaccinated staff member in the breakroom, meeting room, or other areas. If an unvaccinated staff member is present, everyone should wear PPE, and the unvaccinated staff must to physically distance themselves from the other staff in the area.

Quarantine
Fully vaccinated staff who experience a high-risk exposure and who have no COVID symptoms are no longer required to be restricted from work for 14-days following the exposure; they should be tested per the testing guidance mentioned above. Residents, however, who experience prolonged close contact with someone should quarantine for 14-days regardless of the resident's vaccination status and be tested. There is some room to relax resident quarantine in situations where there are critical issues such as lack of space, staff or other concerns. The CDC reminds us to consult with our local public health and infection prevention experts.

Dining & Activities
For activities and communal dining within our settings, fully vaccinated residents may choose to participate in the activity or eat in the dining room; they do not have to wear source control and do not have to socially distance. If unvaccinated residents are present, everyone must wear source control masks, and unvaccinated residents must socially distance themselves from others.

At this point, there is no guidance change that allows for staff to work with residents without appropriate PPE. While the guidance states fully vaccinated residents can be together without masks in certain circumstances and allows fully vaccinated staff to be together without masking in other situations, staff should continue to wear appropriate PPE when working with or around residents.

For questions, please contact Kari Everson, Director of Clinical Care / Nurse Consultant.