Gurwin Pandemic Emergency Plan

The following pandemic plan has been prepared and is submitted in accordance with guidance and regulatory information provided by New York State Department of Health (NYSDOH), Centers for Medicare and Medicaid Services (CMS), Centers for Disease Control (CDC) and Occupation Safety and Health Administration (OSHA) and in preparation for any resurgence of Sars CoV-19 or any such pandemic illness that could potentially be spread at a rapid rate with devastating results amongst the medically fragile residents in nursing homes.

Infectious disease emergencies can include outbreaks, epidemics, and pandemics. The facility has planned effective strategies for responding to all types of infectious diseases, including those that rise to the higher level of pandemic.

This PEP was established to protect the health and safety of Gurwin Jewish Nursing & Rehabilitation’s residents, staff, and visitors; alleviate damage and hardship; and reduce future vulnerability to hazards that may disrupt normal activities of the facility. This PEP is a living document that will be reviewed annually, at a minimum by our Chief Quality Officer. Gurwin’s PEP considers potential hazards from the local area and the impact they could have on the nursing home.  We rely on past experiences and lessons learned in describing risks and include unique physical plant details improving or aggravating the facility’s vulnerability. A Hazard Vulnerability Analysis (HVA) is completed as a facility-based, and community-based risk assessment, utilizing an all-hazards approach to develop a common understanding about the hazard risks that Gurwin faces.  The HVA helps prioritize issues for the PEP to address, by creating an orderly process for identifying the facility’s highest vulnerabilities.

The Hazard Annex P: Infectious Disease/Pandemic Plan has been updated to include guidance and formatted to comply with the new requirements of Chapter 114 of the Laws of 2020 for the development of a Pandemic Emergency Plan (PEP). The PEP is designed to easily identify the information needed to effectively plan for, respond to, and recover from, natural and manmade disasters.

Gurwin Jewish Nursing & Rehabilitation Center is committed to taking the following action regarding the consideration of the following areas of concern:

Communication Plan

A.  To adequately address the communication requirements during a potential outbreak of pandemic illness the facility has developed a record of telephone contacts for all authorized resident family members/guardians who will include a secondary backup contact as This information is collected by the Admissions/Social Work department upon admission or from the Patient review Instrument (PRI) and is available to all staff in the profile section of our Electronic Medical Record (EMR), Point Click Care.

B.  Admission Department and Public Relations Officers will ensure that there is an accurate list of each resident’s representative.

C.  The Corporate Communications team will update the facility website on the identification of any infectious disease outbreak or potential pandemic at the instruction of the Infectious Preventionist/designee.

D.  Facility communication regarding those who have passed away or become infected with pandemic illness will be made at least once per day and upon any change in resident condition, identification of illness, or death. These updates will be made by telephone or by such other means as may be selected by each authorized family member or guardian. Notification timelines are subject to change based on guidance set forth by the CDC or NYSDOH.

E. The Infection Control Preventionist/Designee will be responsible to report communicable diseases on MHSN and via NORA, NYSIIS, as directed by CMS.

F.  The facility will utilize phone calls, mailings, email, internet, and posted signage to alert visitors, family members, and employees about the status of the infectious disease in the facility/community. Gurwin will maintain the promotion of communication between residents and representatives by providing access to no-cost, daily remote video conference and will continue to offer communication via Skype / Facetime and telephone with assistance provided by arranged appointment through the Therapeutic Recreation and Social Work department Instructions for Skype and Facetime are available to resident representatives and can be found on the facility website with any questions or inquiries on this program to be forwarded to the of Therapeutic Recreation or designee.

G.  The facility will implement procedures to provide residents, relatives, and friends with education about the disease and the facility’ s response strategy at a level appropriate to their interests and need for information. These procedures will include online notifications/postings as well as phone calls, town hall meetings, posted signage, and in-person resident education as applicable and

H.  In accordance with PEP requirements, the facility will follow procedures to post a copy of the facility’s PEP, in a form acceptable to the commissioner, on the facility’s public website, and make it available immediately upon request Administration will review this Pandemic Emergency Plan annually and as needed as new information becomes available.

I.  The facility will communicate any relevant activities regarding recovery/ ret urn to normal operation s with staff, families/guardians, and other relevant These updates will be made electronically through online notifications/postings as well as phone calls, or by such other mean s as may be selected by the administration, representative or guardian.

J.  The facility will contact all staff, vendors, other relevant stakeholders to provide the facility’s updates to policies and procedures related to minimizing exposure risks to residents and themselves. These updates will be made available electronically, through the facility intranet, robo calls, phone calls or by such other means as may be selected by the Administration as applicable and appropriate.

Facility Process for Staff Education

A plan is in place to provide education and training to ensure all personnel understand the implications, and basic prevention and control measures, including recognizing exposure risks and utilizing personal protective equipment (PPE) correctly, reporting requirements, and regulations.

1. 1.  All staff currently receive Infection Control In-service upon orientation, annually, and as needed as required by NYSDOH. This includes but is not limited to, appropriate hand hygiene and Donning/Doffing of Personal Protective Equipment (PPE).
   2.  The Education Coordinator and ICP have been designated with the responsibility for coordinating education and training on the Infectious Disease/Pandemic Emergency Plan.
   3.  Education and training include information on infection control measures to prevent the spread of Infectious Disease/Pandemic Illnesses, correct use of PPE, exposure risks, screening and detection, and reporting requirements and regulations.
   4.  The ICP/Education Coordinator will conduct annual competency-based education on hand hygiene and donning/doffing PPE for all staff.
   5.  Current and potential opportunities for long-distance (e.g., web-based) and professional programs will be identified as resources for education.
   6.  Language and reading-level appropriate materials will be identified to supplement and support education and training programs.
   7.  Pandemic Illness relevant education will be provided to all departments with oversight by each department This staff education will be provided in-person, with the aid of video recordings and/or via computer-based methods as needed, as well as in the form of town hall meetings as considered appropriate by administration
   8.  Gurwin Jewish Nursing & Rehabilitation Center is committed to incorporating lessons learned from previous pandemic responses into planning efforts to assist with the development of policies and procedures related to such elements as the management of supplies and PPE, as well as implementation of infection control protocols to assist with proper use and conservation of PPE.
   9.  Based on ongoing facility Infection Prevention and Control assessments, staff will be re-in­serviced at a higher rate of frequency as deemed necessary by the Chief Nursing Officer/Director of Nursing (DNS), Education Coordinator, Infection Control Preventionist or designee.
   10.  Validation of education and staff training will be maintained in the form of sign in sheets, posttests, competency forms, or electronic signature.

Infection Control Considerations

A. Surveillance Methods:

Gurwin Jewish Nursing & Rehabilitation Center will implement heightened surveillance activities for pandemic illness during identified periods of transmission in the community and/or during a declared public health emergency for outbreak or pandemic illness. The Administrator, Chief Nursing Officer, Director of Nursing and ICP will monitor the status of pandemic outbreak through the CDC website, and will monitor for changes in prevention, treatment, isolation, or other recommendations. Heightened surveillance activities will be implemented to limit the transmission of pandemic illness. These include, but are not limited to, screening visitors, staff, and residents.

Enhanced surveillance of residents and staff will be considered on a case-by-case basis in collaboration with the local public health department.  Enhanced surveillance will be based upon the clinical presentation of symptoms, risk factors for exposure, and current   CDC recommendations.

A protocol has been developed for infectious disease surveillance and documentation to identify and detect increase above the established baseline infection rate. This data is reported at QAPI subcommittee meetings to identify trends and any area of improvement.

The facility will utilize morning report to identify any trends and patterns of infection and/or symptoms.

The ICP will monitor and internally review transmission of pandemic illness among staff and residents and report regularly to the QAPI Committee.  Information from this monitoring system will be used Information from this monitoring system will be used to implement prevention interventions (cohorting, isolations, therapeutics) and will be necessary to assess pandemic illness.

1. 1.  The ICP, or designee, has been assigned the responsibility for monitoring public health advisories (federal and state) and updating Administration and members of the pandemic planning committee when a pandemic illness has been reported in the United States and/or nearing its geographic area. The following resources will be utilized for infectious disease threat information and planning:
      a.  The Centers for Disease Control and Prevention Health Alert Network (https//emergency.cdc.gov/han/updates.asp)
      b.  State and local health departments
      c.  Centers for Medicare and Medicaid Services (CMS)
      d.  Professional organizations: Leading Age, GNYH
2.  Evaluation and diagnosis of residents and /or staff with symptoms will follow current CDC guidelines for evaluation of symptoms and laboratory diagnostic procedures. The guidelines will be used to enhance infection control surveillance activities. The ICP will track the following information:
   a. The number of residents and staff who have fever, respiratory signs/symptoms, or other signs/symptoms related to pandemic illness.
   b.  The number of residents and staff who have been diagnosed with the identified pandemic illness and when the first case was confirmed.
   c.  The number of residents and staff who have been tested for pandemic illness (testing in accordance with current NYSDOH and CDC guidelines and priorities).
   d.  Employee compliance with hand hygiene.
   e.  Employee compliance with standard and transmission-based precautions.
   f.  Employee compliance with cleaning and disinfection policies and procedures.
3.  The Director of Purchasing and Chief Housekeeping Officer will be responsible for tracking the supply of personal protective equipment, cleaning/disinfection supplies, alcohol-based hand rub, and other relevant supplies.
4.  Collected surveillance data will be used for reporting to the local health department, NYSDOH, CDC, staff, residents, and resident representatives as per communication plan delineated above.

B.  Screening for Visitors and Staff:

1.  All visitors, vendors, contract staff, and facility staff will be screened for signs or symptoms of possible infection, based on the NYSDOH and CDC defined symptoms of pandemic.
2.  Only one designated entrance will be available to enter when screening is required during pandemic emergency.
3.  The facility utilizes kiosk machines to document screening questions and assess thermal temperature of all people entering facility during pandemic emergency.
4.  Staff members and/or visitors will be screened for recent travel to geographic areas with sustained community transmission during the defined incubation period of the pandemic
5.  The facility will post signage at the entrance noting visitor restrictions and requirements for entrance to the facility.
6.  Any restriction in facility visitation will be posted on website.
7.  PPE will be available at the entrance to the facility and will be required as per CDC, CMS, NYSDOH guidelines.
8.  Visitors will be provided with written directions on any visitation reviewing restrictions/requirements to minimize exposure, the importance of hand hygiene, and donning/doffing of PPE.
9.  Alcohol-based hand sanitizer will be placed in entrance area to facilitate hand hygiene.
10.  Visitors may be excluded from entry to the building if they are currently residing in a community where community-based spread of pandemic illness is occurring or have active symptoms   of pandemic illness.
11.  Visitors will be denied entry into the facility if they exhibit any of the criteria listed above. They may be directed to the Infection Control Preventionist, CNO, Director of Nursing, Administrator, or NCC on duty if they have any questions.
12. Staff who have signs and symptoms of a pandemic illness/infection shall not report to work. Any staff that develop signs and symptoms while on the job shall:
    a.  Immediately stop work and ensure facemask is in place.
    b.  Inform the Infection Preventionist and their immediate supervisor, and include information on individuals, equipment, and locations they may have come in contact with during the portion of their shift worked.
13.  The facility will refer to current NYSDOH and CDC guidance for exposures that might warrant restricting asymptomatic staff from reporting to work.

C. Vendors and Other Relevant Stakeholders

1.  The facility will contact all vendors and other relevant stakeholders on the facility’s policies and procedures related to minimizing exposure risks to both residents and staff.
2.  Vendors will be required to drop off deliveries at designated areas to avoid entrance into the facility as warranted.

D.  Staff Testing Methods:

1. Gurwin Jewish Nursing & Rehabilitation Center shall provide staff testing for pandemic illness in compliance with guidance issued by the CDC, CMS and NYSDOH.
2. All employees of the facility including contracted staff will be required to undergo pandemic related diagnostic testing.
3. Staff who are working from home or on leave do not require testing if they remain offsite. They shall be promptly tested upon return to the facility.
4. Staff who refuse NYSDOH or CDC required testing shall be prohibited from working until testing requirement is fulfilled.
5. Facility shall contract with an outside laboratory, to collect and process tests when Point of Care testing is not available.
6. Testing schedule for all staff shall be coordinated with department heads by the Infection Control Nurse (Infection Preventionist) or designee.
7. Testing shall be performed using methods and intervals recommended by the CDC and NYSDOH.
8. Collected specimen shall be forwarded to laboratory promptly after collection for processing or processed on-site pending the availability of Point of Care testing.
9. A tracking log shall be maintained to ensure proper tracking and documentation of testing, results and employee compliance.
10. The Administrator will ensure ongoing surveillance to ensure compliance with staff and resident testing and results.
11. Gurwin shall provide staff testing for pandemic illness in compliance with guidance issued by the CDC, CMS and NYSDOH.

E. Laboratory Services:

The facility utilizes laboratory services from Northwell Health Lab and will have prearranged arrangements with laboratory services to accommodate any testing of residents and staff, including contract employees.

1. Should the laboratories fail to provide timely or accurate results, alternate vendors/sources of laboratory testing will be explored as deemed appropriate by Administrator.
2. Delays in laboratory results will be reported by the Administrator, CNO, ICP or designee to all appropriate channels, including local and state health departments, and CDC when applicable.
3. The Administrator will ensure ongoing surveillance to ensure compliance with staff and resident testing.

F.  Prevention Program for Staff and Residents:

Gurwin Jewish Nursing & Rehabilitation Center is committed to the prevention of the spread of infectious diseases and pandemic illness among the residents and staff. The following methods of prevention will be adhered to for the safety of the staff and residents of the facility during a NYSDOH or CDC defined insurgence of outbreak or pandemic illness:

1.  The ICP or designee will be responsible for posting signs at the entrance instructing visitors not to visit if they have symptoms of infection.
2.  Restriction of visitors in accordance with local, state and national directives.
3.  The facility has developed a liberal/non-punitive sick leave policy that addresses the needs of symptomatic personnel and facility staffing needs.
4.  All sick calls will be monitored by Department Heads to identify any staff pattern or cluster of symptoms associated with infectious agent/illness. The Department Head will notify ICP/HR with issues identified.
5.  Limited points of entry to the facility will be implemented.
6.  Administrator, CNO, DNS, ICP or designee will consider designated wing/unit or floor to accept new residents during an outbreak of pandemic illness.
7.  The facility has plans for cohorting; including dedicating a group of rooms at the end of a unit, wing, or unit and discontinue any sharing of a bathroom with residents outside the cohort. This dedicated area will be created using moveable ICRA panels. Signage will be on the doors and entrances to clearly identify area and admittance requirements.
8.  The Admissions nurse(s) will screen all new admissions for signs and symptoms of pandemic illness, including recent travel, exposure risk, and laboratory test results.
9.  The RN/NCC on each unit will assess residents for symptoms of pandemic illness/infection upon admission to the facility and implement infection prevention practices for incoming symptomatic residents.

G.  Limited Exposure Procedures:

In the event of a future outbreak or pandemic illness, Gurwin Jewish Nursing & Rehabilitation Center will take the following precautions to ensure limited exposure of staff, residents and resident representatives/guardians:

1. The facility has multiple has private rooms, allowing for seamless transition to required transmission-based precautions. Residents affected by pandemic illness can and will be quarantined in their private rooms, or cohorted when necessary, with like precautions. See Cohort/Isolation plan listed below.
2.  The Administrator, DNS and ICP have worked to incorporate lessons learned from previous pandemic responses into planning efforts that include the development of policies and procedures related to
3.  Such elements as the management of supplies and PPE, as well as implementation of infection control protocols to assist with proper use and conservation of PPE.
4.  Education for residents will be assessed by the ICP or designee by prompting them to answer questions and explain (as applicable) what they can do to protect themselves and their fellow  residents (i.e., handwashing, spatial separation, respiratory hygiene/cough etiquette).
5.  Cancelation of group activities, group therapies, and communal dining as required or recommended by CDC or NYSDOH.
6.  Monitoring of all residents for symptoms of pandemic illness.
7.  Pandemic related diagnostic testing will be offered to all residents, with a record of any resident refusals of testing kept by the ICP.
8.  Restriction of residents with symptoms of pandemic illness to their room as applicable.
9.  Based on the defined requirements of the pandemic illness/outbreak. Gurwin Jewish Nursing & Rehabilitation Center will use Standard, Contact, and/or Droplet Precautions with eye protection unless suspected diagnosis requires Airborne Precautions (e.g. tuberculosis).
10.  Monitoring of staff for symptoms of pandemic Restrict from work and follow current guidance regarding testing and returning to work as needed (e.g., local health department, CDC).
11.  Continued support of hand hygiene and respiratory/cough etiquette by residents, visitors and employees by making sure tissues, soap, paper towels and alcohol­-based hand rubs are readily
12.  Education of staff on proper use of personal protective equipment and application of standard, contact, droplet and airborne precautions, including eye protection. Promote easy and correct use of personal protective equipment (PPE) by:
    a.  Posting signs on the door or wall outside of the resident room that clearly describe the type of precautions needed and required PPE.
    b.  Making PPE, including facemask, eye protection, gowns and gloves, available outside of the residents’ rooms for use during care.
    c.  Positioning a trash receptacle near the exit, inside resident’s room to make it easy to discard PPE.
13.  Administration will consider designating certain areas of the facility for multiple residents with suspected or confirmed cases of pandemic illness, if necessary, these will serve as “quarantine areas,” for cohorting of residents that have been identified as positive or under suspicion.
14.  Protection plans against infection for staff, residents and families, including the maintenance of a minimum of a 60-day supply of infection control personal protective equipment and supplies stored in Central Supply for emergency access.

H. Personal Protective Equipment (PPE):

1. In an attempt to protect all staff and residents from future infection with pandemic illness, Gurwin Jewish Nursing & Rehabilitation Center has acquired an abundance of 60-day emergency supply of Personal Protective Equipment, based on the burn rate calculated from 4/19-4/27/2020 (the height of the Sars CoV-19 pandemic). The facility remains committed to maintaining an emergency onsite supply of PPE as required by NYSDOH, with amount and items subject to change based on pandemic specific requirements. The following PPE is currently available:

a.  N95 respirators
b.  Face shields
c. Eye protection
d. Gowns/isolation gowns
e. Gloves
f. Masks
g. Sanitizers and disinfectants

2. The following departments have input in selecting, acquiring, and reviewing the policies for stocking needed supplies: Medical Director, CNO, DNS, ICP, Safety Officer, Chief Housekeeping Officer, Director of Pharmacy, Chief Human Resource Officer, Chief Quality Officer, and Purchasing Director, as well as local and state public health authorities.
3. This supply of PPE for emergency use will be stored in Central Supply – a non-­resident area – where it can be easily accessed in the event of an emergency.
4. The ICP or designee will be responsible for ensuring that staff are using PPE properly (appropriate fit, don/doff procedure, appropriate choice of PPE per procedure).
5. The Infection Control Preventionist and Director of Purchasing will work together to manage the supply of PPE, keeping track of the following:
   a. Current inventory.
   b. Ability to obtain additional inventory from vendors, healthcare coalitions, and public health partners.
   c.  The facility’s PPE utilization rate.
6. Based on the availability of required PPE, the Administrator, CNO, DNS, or designee will determine the need to transition to contingency or crisis strategies for the use of PPE and will relay this to staff as recommended by NYSDOH or CDC standards for preservation of PPE if/when supply chain concerns should arise.
   a.  Staff will be educated on the processes associated with conventional, contingency, and crisis strategies for the use of PPE, should shortages or supply chain issues arise.
   b.  Staff will be educated on the why, what and how of PPE use and will demonstrate competency with donning and doffing PPE.

I. Cohorting and Isolation:

A plan has been developed for cohorting symptomatic residents or groups using one or more of the following strategies:

1. Confining symptomatic residents and their roommates to their rooms.
2. Placing symptomatic residents together in one area of the facility.
3. Cohorting into groups in relation to lab tests (positive, negative, unknown); or
4. Closing units where symptomatic residents reside.

The residents in the facility will be cohorted based upon their status in accordance with CDC and NYSDOH guidance. Staff will be educated on the specific requirements for each cohort.

Transmission-Based Precautions are initiated when a resident develops signs and symptoms of a transmissible infection; arrives for admission with symptoms of an infection; or has a laboratory confirmed infection; and is at risk of transmitting this infection to other residents. The facility makes every effort to use the least restrictive approach to managing individuals with potentially communicable infections. Transmission-Based Precautions are used only when the spread of infection cannot be prevented by less restrictive measures. Transmission-based precautions will be implemented including contact and droplet precautions as needed based on identification of pandemic illness transmission route.

The facility has developed the following plan regarding transmission-based precautions, isolation and cohorting to reduce the spread of pandemic illness throughout the facility:

1. If a resident is suspected of, or identified as, having a communicable infectious disease, the NCC notifies the Infection Control Preventionist and the resident’s Attending Physician or physician extender for evaluation of appropriate Transmission -Based Precautions.
2. Personal Protective Equipment (e.g., gloves, gowns, masks, ) will be maintained in or near the resident’s room so that everyone entering the room can access what they need to provide care.
3. The facility will post the appropriate signage by the room entrance door that all personnel will be aware of precautions or be aware that they must first see a nurse to obtain additional information about the situation before entering the room.
4. An appropriate waste receptacle will be placed inside the resident’s room, near the exit, for prompt and efficient doffing of contaminated PPE.
5. Necessary equipment and supplies that will be needed during the period of transmission-based precautions will be placed inside the room and left inside the room, and these items (preferably disposable, as available) should be used for the provision of care.
6. Cleaning and disinfecting will be performed with an appropriate product on all reusable equipment prior to reuse.
7. An adequate supply of antiseptic soap and paper towels is maintained in the room during the isolation period.
8. An ABHS will be maintained in the resident’s room or hallway outside of room (First Floor).
9. Staff will inform the resident (and/or resident representative) the reason(s) for the required precautions.
10. Transmission-based precautions shall remain in effect until the Attending Physician or physician extender discontinues them, which should occur after pertinent criteria for discontinuation are met.
11. Residents who have been admitted during an outbreak/pandemic who have had a risk of exposure will be considered suspected cases as a standard precaution for the length of the time identified as the pandemic illness incubation period or as defined by the CDC/NYSDOH.
12. Residents receiving dialysis or chemotherapy services outside of the facility will be considered monitored for any change in condition related to the pandemic.
13. All residents will be encouraged to remain in their room with doors closed as tolerated and medically safe. Face mask covering will be encouraged as tolerated during direct care and whenever transported out of room.
14. When shared bath space/shower rooms cannot be avoided or appropriately cohorted due to the structure of the building, residents who are maintained on transmission­ based precautions will receive bed baths for the duration of the precautions.

J. Signage:

1. 1. Proper signage for appropriate transmission-based precautions (as indicated by CDC/NYSDOH requirements) will be clearly posted at the entrance to each resident’s room that has been placed on precautions.
   2. Administration will consider designating certain areas of the facility for multiple residents with suspected or confirmed cases of pandemic illness, if necessary, these will serve as “quarantine areas,” for cohorting of residents that have been identified as positive or under Additional signage will be added to prevent staff and residents from entering the dedicated quarantine area unless they have been assigned to that unit/cohort.

The Infection Control Nurse (Infection Preventionist) or designee will be responsible for posting signs at the entrance to the facility instructing visitors not to visit if they have signs/symptoms of infection.

K. Dedicated Staffing:

1. 1. During an outbreak or time of pandemic illness staffing assignments will be coordinated to minimize the number of Healthcare Personnel (HCP) who enter the room. Staff will not be floated between units if/when pandemic illness cohorting should become necessary.
   2. Only essential personnel should enter the assigned isolation rooms. Consistent assignments will be followed by staff assigned to the “quarantine unit.”
   3. The facility will bundle care and minimize the number of HCP and other staff who enter quarantine/precaution rooms to reduce the incidence of disease transmission.
   4. Designated staff assigned to the quarantined residents will not care for any other residents within the facility to prevent disease transmission during assigned shift/day worked.
   5. The facility will keep a record of all persons who care for or enter the rooms or care areas of the quarantine rooms to minimize spread of infection as required. The staff assignment can be utilized to obtain specific residents that the staff member interacted with.

Facility Reporting

A. Staff responsible for reporting:

To ensure seamless and timely reporting of all reportable pandemic related cases/ information, the following job roles are assigned access to The Health Commerce System for required reporting on Health Electronic Response Data Systems (HERDS), National Healthcare Safety Network (NHSN) and Nosocomial Outbreak Reporting Application (NORA):

1. Chief Nursing Officer
2. DNS
3. ICP
4. Administrator

B. Information to be reported:  The facility has developed policies and procedures for reporting to NYSDOH, CDC and local health department as appropriate:

1. Any single case of a reportable communicable disease or unusual disease (defined as newly apparent or emerging disease or syndrome that could possibly be caused by a transmissible infectious agent or microbial toxin) will be reported to the local health department.
2. If a reportable communicable disease is suspected or confirmed to be acquired at the nursing home, it will also be reported to the NYSDOH. This will be done electronically via the NORA or by faxing an Infection Control Nosocomial Report Form (DOH 4018).
3. Reports will be made in the manner required by the local health department in Nassau County and will be submitted within 24 hours of diagnosis of pandemic illness.
4. The ICP/Designee will enter data in the NHSN as per CDC/CMS guidance.

C. Categories and examples of reportable healthcare-associated infections include but are not limited to:

1. 1. An outbreak or single identified case of disease due to any infectious agent (e., staphylococci, vancomycin resistant enterococci, Pseudomonas, Clostridioides difficile, Klebsiella, Acinetobacter) occurring in residents or in persons working in the facility.
   2. Intra-facility outbreaks of coronavirus, influenza, gastroenteritis, pneumonia or respiratory syncytial virus.
   3. Foodborne outbreaks.
   4. Infection s associated with contaminated medications, replacement fluids, or commercial products.
   5. Single cases of healthcare-associated infection due to any of the diseases on the Communicable Disease Reporting For example, single cases of nosocomial acquired Legionella, measles virus, invasive group A beta hemolytic Streptococcus.
   6. A single case involving Staphylococcus aureus showing reduced susceptibility to vancomycin.
   7. Clusters of tuberculin skin test conversions.
   8. A single case of active pulmonary or laryngeal tuberculosis in a nursing home resident or employee.
   9. Increased or unexpected morbidity or mortality associated with medical devices, practices or procedures resulting in significant infections and/or hospital admissions.
   10. Closure of unit or service due to infections.

 Resident Readmission after Hospitalization

1. Gurwin Jewish Nursing & Rehabilitation is sensitive to the needs of our surrounding hospitals and will make our best effort to hold a hospitalized resident’s bed for as long as possible in the event of an outbreak/pandemic illness in accordance with all applicable laws and regulations.
2. Residents hospitalized during an outbreak/pandemic illness will be readmitted to the facility unless the time comes that holding the resident’s bed becomes a financial burden on the facility, the facility is unable to meet the required safety or clinical needs of the resident, or that the bed is needed for another admission.

Administrative Controls

A. The facility will maintain review of, and implement procedures provided in NYSDOH and CDC recovery guidance that is issued at the time of each specific infectious disease or pandemic event, regarding how, when, which activities/procedures/restrictions may be eliminated, restored and the timing of when those changes may be executed.

B. In an emergency, the Administrator, Chief Nursing Officer, Director of Nursing and/or Medical Director shall have the administrative authority, accountability and responsibility to:

1. 1. Institute all actions necessary to control or prevent infections within the
   2. Notify the health department of reportable diseases, as appropriate.
   3. Initiate isolation precautions, including the dedication of a dedicated “Quarantine Unit.”
   4. Obtain laboratory specimens.
   5. Restrict and/or ban admissions.
   6. Restrict and/or ban visitation for residents.
   7. Implement other measures as necessary to prevent and control infections within the facility (e.g., creating quarantine units staffed with designated staff).
   8. Resident suspected of transmissible illness during a pandemic will be placed on necessary precautions.
   9. Residents positive for transmissible illness during a pandemic will be placed on necessary precautions.
   10. The policy on Communal dining and recreational activities will be reviewed and revised during pandemic emergency based upon NYSDOH, CMS, and CDC guidelines.
   11. The facility will adhere to directives by the NYSDOH, CMS, and CDC at the time of the pandemic event, e.g., regarding how, when, which activities/procedures/restrictions may be eliminated/restored and the timing of when these changes may be executed.
   12. Social distancing recommendations will be followed on resident care units and employee shared space areas. Signage will be utilized to ensure compliance.

C. Visitation restrictions:

       Definitions:

• Personal caregiving visitor means a family member, close friend, or legal guardian of a resident designated by such resident, or such resident’s lawful representative, to assist with personal caregiving or compassionate caregiving for the resident.
• Personal caregiving is defined as care and support of a resident to benefit such resident’s mental, physical or social well-being.
• Compassionate caregiving is defined as personal caregiving provided in anticipation of   the   end of the resident’s life or in the instance of significant mental, physical, or social decline or crisis.
• Restricting visitation means the individual is not allowed in the facility at all.
• Limiting visitation means the individual is allowed to come into the facility in certain compassionate situations, such as end-of-life situations, but with limited access in the facility and with certain conditions to prevent the potential spread of infection.

1. 1. Gurwin Jewish Nursing & Rehabilitation Center will restrict visitation of all visitors and non- essential health care personnel for the duration of the declared national and public health emergency related to pandemic illness in accordance with current CMS directives and CDC recommendations, or as directed by NYSDOH (whichever is more stringent).
   2. The facility will allow Personal Caregiver visitation, as contained in 10 NYCRR 415.3 (d)(3) and NYCRR 485.18 (c), to permit visitation in the facility during public health emergency, despite general visitation restrictions in the facility and subject to certain limitations.
   3. Compassionate care giving visitation will not be restricted during pandemic emergency;  Decisions about visitation during an end-of-life situation will be made on a case- by-ca se-basis by Chief Social Worker, Medical Director, Administration, CNO/Designee.
   4. The Infection Control Nurse Preventionist or and Administrator will monitor the status of the pandemic illness situation through the CDC website and local/state health department and will keep facility leadership informed of current directives/recommendations and the need for restricting/limiting visitation.
   5. Gurwin will communicate these amendments to their visitation policy through multiple channels including using signage, calls, letters, social media posts and emails, instructing visitors to defer visitation until further notice.

Considerations when limiting visitation:
a.  Visitors will be screened as per methods delineated above and those that do not meet the screening requirements will not be permitted to enter.
b.  Each visitor will be required to wear a face mask. Additional personal protective equipment (PPE) will be required in accordance with transmission-based precautions. Each will be required to perform hand hygiene upon entry.
c.  The visitor is limited to the location designated by the facility.
d. The visitor will refrain from physical contact with residents and others while in the facility. For example, practice social distancing with no handshaking or hugging and remaining 6 feet apart.
e.  Modify interactions with volunteers, vendors, EMS personnel, transportation providers, and other practitioners to prevent any potential transmission.
f.  Follow all guidelines from NYSDOH, CDC, CMS regarding visitation and restrictions.

D. When staffing shortages are anticipated:

1.  Our facility administration will collaborate with Human Resources for any available agency contacts to plan and prepare for mitigating staffing shortages.
2.  The facility has a plan for expediting and training staff brought in from other locations to provide resident care when the facility is anticipating staffing crisis.
3.  Each department has developed a contingency staffing plan that identifies minimum staffing needs and prioritizes critical and non-essential services, based upon resident needs and essential facility operations. The plan includes collaboration with local and regional DOH and CMS to address widespread healthcare shortages during a crisis.
4.  The facility will utilize CDC’s mitigation strategies to provide a continuum of options for addressing staffing shortages. Contingency, followed by crisis capacity, strategies augment conventional strategies and will be considered and implemented sequentially.
5.  The facility will review the current staffing patterns to understand their staffing needs to provide a safe work environment while providing resident care.  The facility will communicate as needed with the local healthcare coalitions, federal, state, and local public health partners (e.g. public health emergency preparedness and response staff) to assist the facility in hiring additional healthcare personnel (e.g. hiring additional HCP, recruiting retired HCP, and using students and volunteers) when needed.
6.  The facility will attempt to hire nursing personnel to address workforce shortages over the course of the nationwide public health emergency.
7.  The Chief Human Resource Officer, Administrator, Chief Nursing Officer and DNS will meet with the healthcare staff to collaborate ways in which they can postpone their elective time off from work during pandemic emergency. In the event of a staffing shortage, all resident non-essential medical appointments will be canceled and re-scheduled after the pandemic illness/outbreak subsides. Only dialysis residents and chemotherapy residents will continue to go on routine scheduled appointments.
8.  In reaction to a staffing shortage, residents will utilize telemedicine in conjunction with services provided by the Medical Providers when conducting medical health visits rather than sending them out of the facility for a Physician consultation visit as deemed appropriate by Medical Director, Attending Physician or physician extender.

Environmental Controls

A. The facility will conduct cleaning/decontamination in response to the infectious disease/pandemic illness in accordance with any applicable NYSDOH, EPA and CDC guidance, as well as with facility policy for cleaning and disinfecting of isolation rooms.

1. Contaminated waste on the resident units will be disposed of in black bins. These bins are in soiled utility rooms.
2. Storage areas for contaminated waste are clearly identified as per NYSDOH guidelines.
3. Contaminated waste and laundry bins will be located inside resident rooms for those residents placed under transmission-based precautions.
4. The bags are then collected securely by dedicated housekeeping staff and transported for vendor pickup/disposal. The housekeeping staff will be trained and demonstrate competency in handling infectious waste. PPE will be utilized when performing these tasks.
5. The facility will amend its policy on biohazardous waste as needed related to any new infectious agent and mode of transmission.

B. The Chief Housekeeping Officer is directly involved in purchasing cleaning products.

C. The ICP will be responsible to ensure that all disinfecting products purchased for the facility are on the FDA approved list.

D. The Administrator works directly with Director of Purchasing and vendors to procure PPE and other needed emergency supplies.

E. The following plan has been developed to ensure vendor supply of food, water, medications, and sanitizing agents (as well as other necessary supplies) in the event of a pandemic illness outbreak:

1. The facility surplus of PPE and sanitizing agents (as listed above) will be kept in Central Supply (non-resident area) and locked cage area for emergency access in the event of an outbreak of pandemic illness. PPE inventory will be monitored by the Director of Purchasing/ Administrator/ designee.
2. The Chief Housekeeping Officer will monitor to ensure the designated par level supply of cleaning/sanitizing materials is available.
3. A 3–4-day emergency supply of food and water are available. This supply is monitored on quarterly basis to ensure its intact and safely stored.
4. The Director of Pharmacy ensures that a 90-day supply of stock medications are available
5. The Department Head/Designee responsible for monitoring the emergency supplies will notify the Administrator for any specific needs or shortages.

Return to Normal Operations

A. The facility will maintain communication with the local NYSDOH and CMS and follow their guidelines for returning to normal operations.

B. The facility will update the website when restrictions are eliminated, and normal operations occur

C. Resumption of services from non-essential employees will be made based upon CMS and NYSDOH recommendations.

D. Monitoring of residents and employees will continue as directed by NYSDOH.

July 2022