Contact tracing is less effective in a larger outbreak (more than 3 new resident or staff cases within 7 days) and when adequate numbers of staff trained to do the contact tracing are not available. In these situations, the CDC recommends a broad-based approach, which is a geographic approach to outbreak management.
- Identify Residents and Staff for geographic outbreak management. Determine the geographic areas of the facility where positive residents and/or staff were present, starting 2 days before the most recent case Onset Date. If over 75% of the facility is affected, test all facility residents and staff. Include all staff who routinely these areas or are assigned to these areas, including non-clinical staff and staff from non-nursing disciplines.
- All staff members should self-monitor for fever and symptoms of COVID-19 for 14 days after the most recent Onset Date and not report to work when ill or if testing positive for COVID-19 infection.
- All residents in the affected geographic areas who are unable to tolerate wearing a mask are placed in quarantine for 14 days after the most recent case Positive Date. Follow Exposed Resident workflow.
- All staff members in the affected geographic areas should wear eye protection (face shield) when within 6 feet of a resident, and a respirator (not a mask) at all times for 14 days after the most recent case Positive Date. Notify the staff member(s) of their respirator and eye protection requirements:
- Must wear a respirator (not a mask) at all times when in the facility, removing the respirator only when eating or drinking.
- Must wear eye protection when within 6 feet of a resident.
- Eating and drinking are only permitted in areas where residents are unlikely enter, and while physically distanced from all other people. These staff members may not eat or drink in a resident care area.
- Test all identified residents and staff every other day until at least 3 tests are performed. If additional cases are identified, test all identified residents and staff every 2-3 days for 10 days after the most recent case Onset Date.
- Test staff with a Point-of-Care Antigen or PCR COVID-19 test.
- Test residents for COVID-19 (PCR test preferred, but Point-of-Care Antigen test is acceptable).
- Document all residents and staff identified for testing and the dates and results of all tests. Consider using a Heat Map to follow the course of the outbreak.
- Do not test any residents or staff within 1 month of the onset of confirmed COVID-19 illness.
- For staff and residents within 3 months of confirmed COVID-19 illness, Point-of-Care Antigen testing is used. Antigen testing reduces the possibility of identifying a “persistent positive” resident.
- Residents may decline testing.
- A registered nurse will provide counseling to the resident regarding the type of test used, the benefits of testing to the resident and the other facility residents, and the risks of declining testing. Document any resident declinations of testing and the counseling provided in the medical record.
- Residents who decline testing and have symptoms of COVID-19 illness should be isolated separately from residents who declined testing and do not have symptoms.
- Residents with an exposure who decline testing and are unable to tolerate wearing a mask are placed in Quarantine for 14 days after the most recent case Positive Date.
- A staff member that refuses testing is considered to have an outdated or incomplete health assessment and shall be prohibited from working for the nursing home or adult care facility until they complete testing.