LRCS COVID-19 Protocols

Protocol #1 Nursing Protocol for Preventing Exposure: Preventing Exposure to COVID-19 in LRCS Staffed Programs

All LRCS Employees are instructed to:

Take the following Relias Trainings
1. Hand Hygiene: The Basics
2. Infection Control: The Basics
Watch the following
1. Understanding Coronavirus and How to Keep You and Yours Safe
Follow the Governor’s Recommendations under the “Stay-at-Home” order
Follow the CDC’s Social Distancing Guidelines
Be aware of symptoms of COVID-19, which can include:
- Fever (measured or feeling feverish such as feeling warm or feverish),
- respiratory illness, such as cough, sore throat, runny nose, or shortness of breath,
- mild flu-like symptoms, such as fatigue, muscle aches, headache, or
- New symptoms of loss of taste and smell.

Prevention Measures:

Visitors
1. All Visitors to any LRCS staffed program or building will be required to sign in a visitor log which includes a brief health status questionnaire. Any visitor who has traveled internationally or on a domestic air, train, subway or bus in the last two weeks, is experiencing cold or flu symptoms, or has a fever over 100 will not be allowed entrance.
2. After signing in and answering disclosures with acceptable outcomes, visitors will wash their hands before doing anything else in the building.
Staff
1. Staff working in an LRCS building, not providing direct support, or staff working direct support other than in an LRCS Staffed residence, (this includes Home Assist and Staffworks Employees) before leaving home for work, will take their own temperature. If they are experiencing cold or flu symptoms, or have a fever over 100, they will call their supervisor and will not report to work.
2. Staff working in an LRCS staffed residence, will take the measures outlined in the prior step, in addition, upon arriving at the staffed residence they will work in for their shift, they will sign off on a disclosure statement that they are not experiencing cold or flu symptoms, and will again take their own temperature and record it on the disclosure statement.
Individuals
1. LRCS Staff will take the temperature of individuals in staffed residences daily in the morning prior to medication administration and record the temperature on log in the home and call nursing if temp is 100 or greater.

Protocol #2 – Nursing Protocol for Exposure: Cases of COVID-19 in Employees or LRCS Staffed Programs

Suspected Cases of COVID-19

Any LRCS staffed program (Staffworks, Home Assist and Residential) serving an Individual with suspected COVID-19 should immediately contact LRCS Nursing, who will contact the Division of Public Health Services (DPHS) in Concord, 271-4496 (am) or 271-5300 (pm) to review the risk assessment and discuss laboratory testing and control measures. The Director of Nursing will also notify the LRCS CEO.

These control measures include the following:

Provide PPE, such as a face mask, for the Individual exhibiting symptoms of COVID-19.
Isolate the Individual in a private room with the door closed.
- Considerations may be necessary in order to provide effective communication access for individuals with disabilities.
If you are in the same room as the Individual, wear a face mask and stand at least 6 feet away.
Ask the Individual about symptoms of COVID-19 (fever, cough, difficulty breathing). Other symptoms could include: chills, sore throat, headache, muscle aches, abdominal pain, vomiting, and diarrhea.
If possible, LRCS Nursing should immediately assess the Individual using appropriate PPE, if available.

If the Individual requires immediate medical care, call 911 for an ambulance and inform EMS of the Individual’s symptoms and concern for COVID-19.

Confirmed Cases of COVID-19

Any LRCS staffed program (Staffworks, Home Assist and Residential) serving an Individual with a confirmed case of COVID-19 should immediately contact LRCS Nursing, who will contact the Division of Public Health Services in Concord, 271-4496 (am) or 271-5300 (pm) to review the risk assessment and discuss laboratory testing and control measures.

These control measures include the following:

Hand washing is the single most important you can do at this time, washing your hands for 20 seconds with soap and water, using hand sanitizer if soap and water are not available.
Provide hand over hand assist to all individuals when it comes time for them to wash their own hands.
Staff and individuals hands should be washed upon entering a building, before and after eating, before and after toileting, after someone has touched their face, after coughing or sneezing, before and after glove removal and mask removal (if delegated to wear one).
Close off all areas used by the ill person. If the exposed area(s) can be isolated, the remainder of the home may remain open.
The individual needs to be kept in their room at all times. If using shared bathroom the confirmed individual should be the last shower of the day. Arrangements of commode should be made and confirmed persons should use commode for all toileting and bathroom for showers only.
Once the confirmed person has used the bathroom, the door should be closed (open window if able) for 1 hour before any staff go in to clean and disinfect.
Please be sure to read the back of all disinfectants and cleaning products as the length of time to be left on surfaces varies from one product to another.
If the individual does come out of his her room at any time, they need to wear a mask. If they cannot tolerate wearing a mask, or are not able to place mask on by themselves staff will need to wear masks.
All food and drinks or other items needed to be brought to the individual’s room, if able paper or plastic disposable dinnerware. Before entering they need to have mask on, if unable to put one on themselves staff entering room need to wear appropriate PPE.
If staff are providing either bed baths or showers the individual needs to have a mask on, if they cannot put one before you enter the room or unable to tolerate a mask for the length of task you are providing you need to put one before entering the room.
If staff need to empty commodes or urinals they will need to wear PPE to dispose of waste material.
Open outside doors and window to increase air circulation.
Schedule a deep clean of impacted areas. Wait as long as practical – if possible, at least 24 hours – to begin cleaning and disinfection to minimize exposure to respiratory droplets.
Nursing will continue to instruct and direct care to all individuals who have been confirmed, reminder the best place for the individuals to be is in their homes. Confirmed Covid-19 cases are well managed at home with less risk of secondary infections. Following and maintaining infection control measures will decrease risk of transmission of Covid-19.

Close Contact with Confirmed Case of COVID-19

An employee or Individual may have had close contact with an individual who has tested positive for COVID-19 but has not tested positive themselves.

“Close contact” is defined as living in the same household as a person who has tested positive for COVID-19, caring for a person who has tested positive for COVID-19, being within 6 feet of a person who has tested positive for COVID-19 for about 15 minutes, or has been in direct contact with secretions (e.g., sharing utensils, being coughed on) from a person who has tested positive for COVID-19, while that person was symptomatic.

Close contact which occurred prior to the development of symptoms is not considered to be an exposure. Decisions about who had close contact and implementation of legal quarantine are done through DPHS.

The employee or individual should self-quarantine for 14 days.
Take and record daily temperatures.
Those in self-quarantine who have not developed symptoms and are not considered a high risk for transmission of the virus may return to the home once the 14-day quarantine period has ended.
The home does not need to be closed.
The home does not need to be deep cleaned at this time.
If the exposed employee or Individual subsequently develops symptoms and tests positive for COVID-19, follow the guidelines under Confirmed Cases.

Confirmed Employees Cases Outside of the LRCS Staffed Program

If an employee tests positive for COVID-19 but has not been to the LRCS staffed program while they were symptomatic, no deep cleaning is required.

Follow the CDC Return to work guidelines to determine when an employee may safely return to the facilities.

Providing Care to the LRCS Staffed Programs

Individual programs face unique considerations when an Individual is confirmed to have COVID-19 or has had close contact with an ill person. For example, Home Assist does not have jurisdiction over the homes they enter and should contact their supervisor with concerns.

Determine the Location of Care

The LRCS Director of Nursing will consult DPHS to review the risk assessment and assess whether the individual setting is appropriate for home care or an alternative appropriate place to ensure the safety of the Individual.
- This includes whether the Individual is stable enough to receive care at home, appropriate staff is available, and there is a separate bedroom that the Individual can recover in without sharing immediate space with others.
- The Individual and other household members must have access to appropriate, recommended personal protective equipment – at minimum, gloves and facemask – and must be capable of adhering to precautions such as hand hygiene.
- If other household members are at increased risk of complications from COVID-19 infection (such as people >65 years old or who are immunocompromised), home care may not be appropriate.

On-site Care

If the Individual will be cared for within the home:

Limiting Further Spread

Other household members should say in another room or be separated from the Individual as much as possible.
When there is a need to care for the individual, staff will need to encourage the person to wear a mask, and wash their hands before you can assist them. If the individual cannot wash their hands or apply a mask on independently before you enter the room this is when staff need to wear PPE.
Other household members should use a separate bedroom and bathroom, if available. If not available other should not use the bathroom for an hour after the individual has used, open window after they have finished with the bathroom.
Prohibit any visitors who do not have an essential need to be in the home.
Clean all “high-touch” surfaces within the home every day. Remember to read the back of cleaning and disinfects as the instructions for disinfecting vary.
Limit staff sharing between floors and residences

Individual Care

Make sure any assigned staff understand and can help the individual follow their healthcare provider’s instructions for medications and care. Update nursing with any changes in health.
Help the Individual with basic needs and provide support, as needed, for getting groceries, prescriptions, and other personal needs.
The Individual should wear a facemask around other people. If the Individual is not able to wear a facemask (for example, because it causes trouble breathing), the staff should wear a mask when in the same room as the Individual. Individual should was their hands before and after wearing a face mask.
Avoid sharing household items with the Individual. After the Individual uses items, wash them thoroughly.
Follow the guidelines in the Deep Cleaning section of this guidance regarding cleaning procedures of a Individual’s space.

Deep Cleaning

A deep clean of a home may be required if an employee or Individual is confirmed to have COVID-19 and was present in the home while they were symptomatic.

Definitions

Cleaning refers to the removal of germs, dirt, and impurities from surfaces. Cleaning does not kill germs, but by removing them, it lowers their numbers and the risk of spreading infection.

Disinfecting refers to using chemicals to kill germs on surfaces. This process does not necessarily clean dirty surfaces or remove germs, but by killing germs on a surface after cleaning, it can further lower the risk of spreading infection.

Timing of deep clean procedures

Close off the areas used by ill persons.
Open outside doors and windows to increase air circulation in the area and wait as long as practical before beginning cleaning and disinfection to minimize potential exposure to respiratory droplets. If possible, wait up to 24 hours before beginning cleaning and disinfection.

Personal Protective Equipment

When performing cleaning of any area:

Cleaning staff should wear disposable gloves and gowns for all tasks in the cleaning process, including handling trash.

After cleaning a room or area occupied by ill persons, remove gloves and immediately clean hands.
Cleaning staff and others should clean hand often – including after removing gloves and any contact with a sick person – by washing hands with soap and water for 20 seconds. If soap and water are not available and hands are not visibly dirty, an alcohol-based hand sanitizer that contains 60%-95% alcohol may be used.

Cleaning staff should immediately report breaches in PPE (e.g., tear in gloves) or any potential exposures to their supervisor.

Programs are encouraged to re-educate personnel on proper use of personal protective equipment (PPE) and when to use different types of PPE.

Cleaning Surfaces

Clean dirty surfaces with detergent or soap and water prior to disinfection.
Cleaning staff should clean and disinfect all areas – such as offices, bathrooms, and common areas – that have been used by the ill persons. Focus especially on frequently touched surfaces, including tables, doorknobs, light switches, countertops, handles, desks, phones, keyboards, toilets, faucets, and sinks.

Cleaning Agents

For disinfection, diluted household bleach solutions, alcohol solutions with at least 70% alcohol, and most common EPA-registered household disinfectants should be effective.
Diluted household bleach solutions can be used if appropriate for the surface. Follow the manufacturer’s instructions for application and proper ventilation. Never mix household bleach with ammonia or other cleanser.
A bleach solution can be prepared by mixing 5 tablespoons (1/3 cup) of bleach per gallon of water or 4 teaspoons of bleach per quart of water.
Products with EPA-approved emerging viral pathogens icon are expected to be effective against COVID-19 based on data for harder to kill viruses.
For soft (porous) surfaces such as carpeted floor, rugs, and drapes, remove visible contamination if present and clean with appropriate cleaners indicated for use on these surfaces.

- If the items can be laundered, launder items. Otherwise, use products with the EPA-approved emerging viral pathogens claims (examples at this link) that are suitable for porous surfaces

Linens, Clothing, and Laundry Items

Do not shake dirty laundry – this prevents the possibility of dispersing the virus through the air.
Dirty laundry that has been in contact with an ill person can be washed with other people’s items.
Wash items as appropriate in accordance with the manufacturer’s instructions, using the warmest appropriate water setting, and then dry items completely.
Clean and disinfect hampers or other carts for transporting laundry according to above guidance on cleaning hard or soft surfaces.

Cleaning while Individual is Receiving Care

There are additional deep clean considerations when an Individual with a confirmed or presumed positive case of COVID-19 is being cared for within the home.

In an Individual home where an ill person is being housed in isolation, focus on cleaning and disinfecting common areas where staff and any other person providing services may come into contact with ill persons.
Reduce cleaning and disinfection of bedrooms and bathrooms used by the ill persons to an as needed level to reduce contact.
If a separate bathroom is not available, the bathroom should be cleaned and disinfected after each use by an ill person. If this is not possible, the caregiver should wait as long as practical after use by an ill person to clean and disinfect the high-touch surfaces.

In areas where ill persons have visited or used, continue cleaning and disinfection as provided in this guidance.

Protocol #3 – Reporting Exposure: Reporting Exposure to COVID-19 in Employees or Individuals

Suspected Cases of COVID-19

Any staffed program serving an LRCS Individual with suspected COVID-19, or any LRCS employee with suspected COVID-19, should immediately contact Nursing, who will contact the Division of Public Health Services (DPHS) in Concord, 271-4496 (am) or 271-5300 (pm) to review the risk assessment and discuss laboratory testing and control measures.

The Director of Nursing will also notify the LRCS CEO.

The LRCS CEO will:

Direct a team comprised of Human Resources, Nursing, and the applicable program, to receive guidance from DPHS and determine the level of risk and next steps.

Confirmed Cases of COVID-19

Any staffed program serving an LRCS Individual with a confirmed case of COVID-19, or any LRCS employee with a confirmed case of COVID-19, should immediately contact Nursing, who will contact the Division of Public Health Services in Concord, 271-4496 (am) or 271-5300 (pm) to review the risk assessment and discuss laboratory testing and control measures.

The Director of Nursing will also notify the LRCS CEO.

The LRCS CEO will:

Notify the Bureau of Developmental Services (BDS)
Direct a team comprised of applicable Department heads, such as Human Resources, Nursing, and the applicable BDS Liaison, and the applicable head of the service delivery program, to receive guidance from DPHS and determine the level of risk and next steps.
Direct notification of employees, families, individuals and guardians through Vice President of Human Resources and Public Relations and the other applicable members of Management Team
Copy the Bureau of Developmental Services on communications to families, individuals or guardians.
Direct the enactment of Protocol #2 Exposure to COVID-19.
Any COVID-19 related mortalities require a sentinel event filing with the Bureau of Developmental Services as these are being treated as “unanticipated deaths.”

Protocol #4 Mask Protocol for Preventing Exposure

After checking in using the visitor disclosure form, all visitors entering a LRCS staffed building will be given a washable (reusable) cloth mask to wear to reduce asymptomatic/pre-symptomatic transmission of COVID-19 while in the facility. The mask may be pulled down for purposes of comfort and breathing breaks when the visitor or staff are NOT within 6 feet of another person.

All staff performing direct support will be given the reusable mask by LRCS and will be responsible for washing it in warm soapy water between shifts.

Staff in LRCS buildings will check in for each shift using the staff disclosure form, and will be responsible for bringing a washable (reusable) cloth mask to each shift.

If staff is working in the community or doing home visits, they will be responsible for bringing a washable (reusable) cloth mask and wearing it at minimum while working directly with individuals they support.

A commercial, disposable face mask is likely more effective for this purpose, so if supplies are adequate, a surgical mask can be used instead. When supplies are deemed to not be accurate the disposable masks will be saved for instances of a COVID-19 outbreak.

Important note to communicate to wearers: A cloth mask is NOT personal protective equipment (i.e., it does not protect the wearer, but can protect others in case the wearer is pre-symptomatically or asymptomatically shedding virus).

Staff caring for a patient with suspect/confirmed COVID-19 should remove their cloth face mask, secure it in a plastic bag, conduct hand hygiene, and don usual COVID-19 PPE, which should include at a minimum a surgical face mask, eye protection, gown, and gloves. An N95 or higher level respirator should be used for patients undergoing aerosol-generating procedures.

Anyone wearing a cloth mask must regularly perform hand hygiene and avoid touching their mask and face to avoid contaminating their hands and contaminating surfaces if they are pre- or asymptomatically shedding virus.
Cloth masks should be collected from visitors exiting the facility for washing and re-use. There are designated receptacles in the homes with biohazard labels on each receptacle for collecting masks for either cleaning or disposal.
NH Division of Public Health Services (DPHS) is acquiring a supply of cloth masks for facilities to supplement the supply of community produced masks.

Protocol #5 Auditing Protocols for COVID-19

In order to ensure compliance with LRCS’ COVID-19 Protocols, unannounced audits will be conducted weekly during the entirety of the pandemic response period.

This audit protocol will apply to all additional protocols added after #5.

Audit Procedures:

A Program Manager, Director or Vice President of LRCS will be assigned to conduct an unannounced audit of LRCS Programs they do not directly work in.
Audits will be conducted weekly, randomizing the day of the week the audit takes place.
Auditing may be conducted remotely by asking a manager or staff on location to use Zoom, Facetime or other technology solutions and interact with the auditor.
The “Protocol Audit Form” will be completed and forwarded to the CEO.

Protocol #6 Visitation to LRCS Staffed Residences

Effective Monday, April 13, 2020, and in accordance with Governor Sununu’s Executive Order 2020-04, https://www.governor.nh.gov/news-media/orders-2020/documents/2020-04.pdf LRCS will no longer be allowing visitors to the Community Residences we staff.

This includes:

Old Ward Bridge (Up & Down)
Broader Horizons
Appleridge (Up & Down)
Lewis Street
South Road 1 & 2
Fairview

LRCS is also requesting that Shared Family Living Providers and any family homes that LRCS staff are still supporting to consider adopting this protocol voluntarily.

Other than LRCS staff, the only visitors allowed will be outside contractors required for the health and safety and maintenance of the home, and those visitors are required to follow Protocol #4 for use of masks and signing in.

Any exception to this protocol must be approved by the LRCS CEO. Such exceptions will be made based on criteria set forth in 2020-04: “medically necessary personnel, visitors for residents receiving end of life care, or visitors necessary to provide for a residents psychosocial needs as determined by a licensed medical care provider.”