Coronavirus (COVID-19) - Tips

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Long Term Care

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Introduction

This document is intended for employers, workers and participants of long term care, as an overview of potential hazards in the workplace due to COVID-19.

In all cases, guidance from local public health authorities must be followed and general COVID-19 prevention practices should be implemented, as outlined in Protect Yourself and Others from COVID-19.

Facility Management

  • Increase ventilation rates and fresh air return where possible.
  • Monitor all people for signs and symptoms of COVID-19.
  • Post signs to remind all persons to follow hand hygiene and respiratory etiquette.
  • Limit the number of access points to the facility. Consider having a separate access for health care workers.
  • Screen all persons who enter (health care workers, patients, visitors, contractors, etc.).
  • Only allow essential visitors. Essential visitors can be defined as those who have a resident who is very ill or requiring personal or end-of-life care. Limit visitors to one person at a time for each resident.
  • Install physical barriers such as clear plastic sneeze guards, glass or plastic windows, and curtains between residents as appropriate.
  • Use a separate area for those needing a respiratory virus evaluation.
  • Be aware of cross-contamination through staff, equipment (stretchers, wheelchairs, stethoscopes, blood pressure cuffs), resident belongings, records, linens, clothes, and surfaces such as counters, chairs, handles, and doorknobs.
  • Clean shared equipment, phones, tablets, etc. with alcohol or disinfectant wipes.
  • Make sure workers are trained to work safely, including when replacing the duties of others.
  • Suspend non-essential activities and programming that require additional staff or volunteer support.
  • Cancel all non-essential outings and reassess group activities. If group activities take place, do so with the smallest number of residents possible and maintain 2 metre distances.
  • Clean any shared item between users, including craft supplies, bingo cards, magazines, books, utensils, linens, tools, etc.
  • Encourage residents to clean their hands often (e.g., entering or leaving rooms; before eating, oral care or taking medications; using the washroom; or when hands may be contaminated) or assist if they are unable.
  • Keep teams of workers together in the same area or ward where possible, and so that they are comfortable working in close proximity when absolutely necessary.
  • Identify staff who work in more than one facility only and take steps to limit spread between facilities.

Early Recognition

  • Use routine practices and follow contact and droplet precautions.
  • Triage for risk factors as soon as possible.
  • Monitor residents, staff, and volunteers for risk factors associated with COVID-19, such as fever, acute respiratory illness or new/worsening cough.
  • Isolate those with high risk and provide care using droplet and contact precautions.
  • When transfer is required, transfer residents with severe illnesses by ambulance and notify if COVID-19 is confirmed or suspected. Notify the receiving hospital. Do not use patient transfer services.

If a Person is Suspected of Having COVID-19

  • Follow any isolation protocol in place.
  • Place the patient in a designated separate area or space and use droplet and contact precautions.
  • Do not group with other patients unless necessary, and then only group with confirmed COVID-19 patients.
  • If you are providing continuous positive airway pressure (CPAP) and/or open suctioning to a resident with suspect or confirmed COVID-19, wear all appropriate personal protective equipment, including an N95 respirator and work in a single room with the door closed.
  • Report any individual who may have contracted COVID-19, as required by your jurisdiction.

Personal Protective Equipment (PPE)

  • Train workers on how to work with and care for PPE, and to understand its limitations.
  • Put on and remove PPE in the correct order according to safe work procedures to reduce exposure.
  • Use all of these PPE measures:
    • Gloves
    • Long-sleeved gown
    • Face protection, such as surgical/procedural mask and eye protection, face shield, or surgical/procedural mask with visor attachment
    • N95 respirator (plus eye protection) should be used when performing aerosol-generating medical procedures
  • Reusable respirators, including powered air purifying respirators (PAPRs), must be cleaned and disinfected according to manufacturer’s instructions before re-use.
  • Clean hands with soap and water or an alcohol-based hand sanitizer, especially during and after removal of PPE, and after leaving the resident care area.
  • If there are shortages, PPE should be prioritized for aerosol-generating procedures, care activities where splashes and sprays are anticipated, and high-contact resident care activities. Consider if continuous wear of the same PPE is appropriate when working with residents with the same diagnosis.
  • Improvised or home-made masks are not PPE. Caution should be used. Discuss options with your supervisor, and/or your health and safety committee or representative, and/or union if present.

Environmental Hygiene

  • Make sure contact areas are disinfected, especially all surfaces within 2 metres of a person who has screened positive.
  • Use cleaners to break down grease and remove organic material, or when heavily soiled.
  • Disinfect commonly touched surfaces and shared items, including residents’ rooms:
    • Sanitize utensils and food contact equipment using clean water at 77⁰C or higher, clean chloride solution of at least 100 parts per million available chlorine at 24⁰C or higher, or a clean solution of at least 25 parts per million available iodine at 24⁰C or higher, for at least 45 seconds. Other approved methods are also appropriate.
    • For hard surfaces, use a household or commercial disinfectant cleaning product, or a mixture of 1:9 dilution of bleach (5% sodium hypochlorite) and water. Make sure the solution is in contact with the surface for 1 minute.
    • Disinfect high-touch electronic devices such as keyboards and tablets with alcohol prep wipes, if possible.
  • Use disposable cleaning cloths and gloves.
  • Regularly wash blankets, face cloths, towels, smocks, and bibs on the warmest possible setting.
  • Wash materials belonging to someone with suspected COVID-19 separately. Wear gloves and a gown when handling contaminated laundry, and use a plastic bag for transport.
  • Dedicate equipment to the use of a single resident with suspect or confirmed COVID-19, or clean and disinfect between residents.
  • Remove personal items when a resident is discharged, transferred, or dies. Items with hard surfaces must be cleaned, and other items can be placed in a bag for the family. While risk of transmission is likely low, store the items for 5 days before handling. Items being donated must be thoroughly cleaned and disinfected.

It is important that mental health resources and support are provided to all workers, including access to an employee assistance program, if available.

For further information on COVID-19, refer to the Public Health Agency of Canada.

Note that this guidance is just some of the adjustments organizations can make during a pandemic. Adapt this list by adding your own good practices and policies to meet your organization’s specific needs.

Disclaimer: As public and occupational health and safety information is changing rapidly, local public health authorities should be consulted for specific, regional guidance. This information is not intended to replace medical advice or legislated health and safety obligations. Although every effort is made to ensure the accuracy, currency and completeness of the information, CCOHS does not guarantee, warrant, represent or undertake that the information provided is correct, accurate or current. CCOHS is not liable for any loss, claim, or demand arising directly or indirectly from any use or reliance upon the information.

Document last updated April 28, 2020