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New Visitor Case

Complete Contact Tracing

Complete Contact Tracing beginning 48 hours prior to the Onset Date and continuing until the 14 days after the Onset Date or the last visit to the facility, whichever is earlier. The visitor may have been infectious before the Onset Date, generally considered to be a 48-hour period.

Review the Facility Visitor Log

Review the facility visitor log for any potential exposure events in the 48 hours prior to the Onset Date or between the Onset Date and the Positive Date. Identify all residents visited by the visitor.

Interview Visitor

  • Verify swabbing date and Positive Date, date(s) of visit(s), and symptom Onset Date.
  • The duration of the visit, any close contact with the resident, and mask use.
  • Any other residents, staff or visitors who were within 6 feet of the visitor for more than 15 minutes total over a 24-hour period, and if PPE was used.
  • Inquire about any of the visitor’s other contacts or family members who have visited the facility or may visit the facility. Begin investigations for all such contacts.
  • If the visitor entered any resident unit or other areas of the building where residents were present.

Interview Resident(s)

  • Interview resident(s) visited by the visitor case.
    • Duration of the visit, close contact with the visitor, and mask use.
    • Any other residents, staff or visitors who were within 6 feet of the visitor for more than 15 minutes total over a 24-hour period, and if PPE was used.
    • If the visitor entered any resident unit or other areas of the building where residents were present.

Interview Staff

  • Interview staff on duty during the visitor’s visit(s).
    • Duration of the visit, close contact with the visitor, and mask use.
    • Any other residents, staff or visitors who were within 6 feet of the visitor for more than 15 minutes total over a 24-hour period, and if PPE was used.
    • If the visitor entered any resident unit or other areas of the building where residents were present.
  • Report the above findings to the facility administrator, infection preventionist, and the medical director(s).
  • The resident(s) and staff member(s) who received the visit(s) should be treated as exposed.
    • Exposed staff members should self-monitor for fever and symptoms of COVID-19 for 10 days and not report to work when ill or if testing positive for COVID-19 infection.
    • For each staff member identified as having an exposure, calculate the date through which they need to wear a respirator (KN95 or N95) or well-fitting mask at all times, usually 10 days after the Last Exposure Date. Notify the staff member(s) of their masking requirements:
      • Must wear a respirator (KN95 or N95) or well-fitting mask at all times when in the facility, removing the mask only when eating or drinking.
      • Eating and drinking are only permitted in areas where residents are unlikely enter, and while physically distanced from all other people. Exposed staff members may not eat or drink in a resident care area.
  • For each resident identified as having an exposure, calculate the date that Source Control (masking) or precautions can be removed.

Exposure Testing

In consultation with the infection preventionist and the medical director(s), identify residents and staff exposed by the new visitor case, for exposure COVID-19 testing, regardless of vaccination status. Do not test any residents or staff within 1 month of the onset of confirmed COVID-19 illness. Follow this guidance for any new cases identified.

  • Test exposed staff, with a nasal specimen (Antigen (preferred) or PCR) every other day starting 1 day after the First Exposure Date and continuing until 6 days after the Last Exposure Date (usually a total of 3 tests).
  • Test exposed residents for COVID-19 (PCR test preferred, but Point-of-Care Antigen test is acceptable) who received visits within 2 days of the Onset Date.
    • Test these exposed residents every other day starting 1 day after the First Exposure Date and continuing until 6 days after the Last Exposure Date (usually a total of 3 tests).
    • For residents within 3 months of confirmed COVID-19 illness, use Point-of-Care Antigen testing. 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 10 days after the exposure.
  • A staff member who 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.