Outbreak Plan

Preface

It is our goal to protect our residents, staff, families, and visitors from harm resulting from disasters and/ or exposure to an emergent infectious disease while they are in our facility.

This outbreak response plan is designed to provide guidance for Emerson and all of our constituencies. It is reviewed and updated annually and as needed.

An outbreak is defined as an increase of disease among a specific population in a geographic area during a specific period of time. The types of situations this document addresses include individual cases and/or clusters of:

• Organisms with clinically significant resistance
• Organisms not previously or recently detected
• New/rare clinical presentations of diseases such as COVID-19

This plan correlates with our policies and provides guidance on how to prepare for new or newly evolved infectious diseases whose incidence in humans has increased or threatens to increase in the near future and that has the potential to pose a significant public health threat and danger of infection to the residents, staff and families of Emerson.

Communication Plan

We have developed clear policies for the notification of residents, resident’s families,
visitors, and staff in the event of an outbreak of a contagious disease at Emerson Health and Rehabilitation Center including relevant community outbreaks or other health emergencies. These policies include:

All Snippets

  • Communication methods to notify residents, their families or guardians, and staff about any infectious disease outbreaks which include strategies and methods for virtual communication in the case of visitation restrictions, at a minimum on a weekly basis.
  • Methods to communicate information on mitigating actions implemented by the facility to prevent or reduce the risk of transmission, including if normal operations of the facility will be altered. Notifications shall not include personally identifiable information.
  • Methods to provide cumulative updates for residents, their representatives, and families of those residing in the facilities at least once weekly, in particular during a curtailed visitation period.
  • Written standards, policies, and procedures that provide for virtual communication (e.g. phone, video-communication, Facetime, etc.) with residents, families, and resident representatives, in the event of visitation restrictions due to an outbreak of infectious disease or in the event of an emergency.
  • Visitors- Signs are posted to alert visitors of the outbreak and to ensure those visiting are not ill.
  • In certain times, visitation is canceled as dictated by regulatory officials.

Informing of outbreak or occurrence

Emerson maintains a documented communication plan for informing residents, their representatives, and families of the residents by 5 p.m. the next calendar day following the subsequent occurrence of either:

  • Each time a single confirmed infection of COVID-19 is identified,
  • Whenever three or more residents or staff with new onset of respiratory symptoms occur within 72 hours of each other in accordance with CMS regulatory guidelines.

The local, state and federal health authorities will be the source of the latest information and most up to date guidance on prevention, case definition, surveillance, treatment, and skilled nursing center response related to a specific disease threat.

Contingency capacity strategies to mitigate staffing shortages staffing strategies

When staffing shortages are anticipated, healthcare facilities and employers, in collaboration with human resources and health services, use contingency capacity strategies to plan and prepare for mitigating this problem. As a baseline for staffing Emerson:

Understands our staffing needs and the minimum number of staff needed to provide a safe work environment and safe resident care.

We are in communication with our local healthcare coalitions, federal, state, and local public health partners (e.g., public health emergency preparedness and response staff) to identify additional healthcare professionals HCP (e.g., hiring additional HCP, recruiting retired HCP, using students or volunteers), when needed.

Strategies to secure additional staff in case of a COVID-19 outbreak or any other emergency among staff are an integral component of our Outbreak Plan.

Website and social media platforms

Emerson prominently displays on our website and social media platforms and in communications to families, guardians, and the public, our phone number as a direct method of communication to the facility for questions, urgent calls, or complaints. This number is answered by a staff member 24 hours 7 days per week.

Emerson also provides facetime, cell phone, landline communication, and currently socially distanced outdoor visitation and window visits as other means for our residents to communicate with family and friends.

At a minimum on a weekly basis, we update our website to share our facility status and include a photo gallery of what is happening in their loved one’s environment.

Testing and data reporting requirements

Emerson meets all testing and data reporting requirements of residents and staff as outlined by the NJDOH.

Emerson has registered and is authorized NJDOH to access data and is entering information in the NHSN COVID-19 Module twice weekly as required.

Personal Protective Equipment (PPE)

As a stand-alone facility, Emerson utilizes the Centers for Disease Control (CDC) PPE Burn Rate Calculator and accordingly always has two (2) months of PPE on hand in accordance with NJDOH requirements.

PPE re-stocking

If Emerson should use our stockpile of PPE in an emergency, we re-stocked our PPE in compliance with NJDOH requirements and in accordance with our calculated burn rate.

Activation of the Outbreak Plan

Through our Infection Control and Surveillance plan, we maintain and activate as needed protocols for isolating and cohorting infected and at-risk Residents in the event of an outbreak of a contagious disease until the cessation of the outbreak

We are contracted for laboratory testing, and the labs are available as needed.

Monitoring of thresholds

Emerson monitors reports from disease intervention specialists (DIS) or clinical providers.

We also monitor whenever disease levels exceed what is expected in a given community (either at Emerson or in our immediate community area).

Maintaining emergency preparedness for a health crisis/pandemic

As part of our ongoing monitoring protocols through our Infection Control and Surveillance Program, our Emergency Preparedness Program, and our Education Program, we continuously monitor the following elements of our operations.

  • Review of educational needs
  • Review of staffing, resources, supplies, and support available
  • Review of testing protocols and treatments
  • Reviewing transfer agreements with other facilities
  • Review of protocols
  • Review of regulations

Emergency staffing

Administration will consider its requirements under OSHA, (Center for Medicare and Medicaid CMS), state licensure, Equal Employment Opportunity Commission (EEOC), American Disabilities Act (ADA) and other state or federal laws in determining the precautions it will take to protect its residents. Protecting the residents and other employees shall be of paramount concern. Management takes the following considerations into account:

  1. The degree of frailty of our residents.
  2. The likelihood of the infectious disease being transmitted to the residents and employees.
  3. The method of spread of the disease (for example, through contact with bodily fluids, contaminated air, contaminated surfaces).
  4. The precautions which can be taken to prevent the spread of the infectious disease and
  5. Other relevant factors. Once these factors are considered, the Home will weigh its options and determine the extent to which exposed employees, or those who are showing signs of the infectious disease, must be precluded from contact with residents or other employees.
  6. Apply whatever action is taken uniformly to all staff in like circumstances.
  7. Employees who refuse at any time to take the precautions set out in this and other
  8. Facility policies may be subject to discipline including not being allowed to work.

In an emergency situation, the Administrator, Human Resources, and key staff will meet for briefing on staffing needs and to implement the strategy to secure staff if an outbreak takes place. This will include reviewing:

  1. On-duty staff and scheduled staff. During an emergency, staff currently on duty will be required to stay on duty until they are relieved by other staff.
  2. Off-duty staff and on-call staff, including department managers.
  3. Non-medical volunteers (if permitted) who are already on file with the facility.
  4. Healthcare professional volunteers who present to the facility to help.
  5. (pending criminal background checks).
  6. Non-medical staff and (volunteers if permissible) will only be assigned to and perform non-medical tasks.
  7. Every effort shall be made to ensure that no staff work greater than 16 consecutive hours.

Specific to Coronavirus

It is the policy of Emerson Health and Rehabilitation Center to minimize exposures to respiratory pathogens and promptly identify residents with Clinical Features and an Epidemiologic Risk for the COVID-19 and to adhere to Standard, Contact and Airborne Precautions. Staff will be correctly trained and capable of implementing infection control procedures and adhere to requirements.

Clinical leadership will be vigilant and stay informed about emerging infectious diseases (EIDs) around the world. They will keep administrative leadership briefed as needed on potential risks of new infections in their geographic location through the changes to existing organisms and/or immigration, tourism, or other circumstances.

As part of the emergency operations plan, the facility will maintain a supply of personal protective equipment (PPE) including moisture-barrier gowns, face shields, surgical masks, assorted sizes of disposable N95 respirators, and gloves.

The amount that is maintained in storage will minimally be for 60-days (2 months) worth of use. The daily burn rate is monitored. We will regularly train employees and practice the EID response plan through drills and exercises as part of our emergency preparedness training.

Communication with Government/Health Agencies

Based on the situation at hand, the Administrator/designee is responsible for notifying the County and/or State Health Department and any other relevant agencies. As necessary, the Administrator/ designee will reach out to other healthcare organizations including hospitals as well as emergency medical personnel, medical staff, Ombudsman’s office, medical transport companies, vendors as needed, insurance companies as required, and the Office of Emergency Management. The Administrator/designee reports the required information (including line lists) into the NJHA and NHSN systems and via e-mail daily, as required by CMS, the NJ Department of Health, and the County Health Department.

Website Information

Emerson’s website http://emersonhealthcare.com includes a copy of this Outbreak Plan, update on facility status, and ways to communicate with loved ones and staff.

Lessons Learned

  • Ensure Response Team in place to provide direction on overall Outbreak Response Plan.
  • Ensure clear comprehensive protocol in place for assessing, testing, cohorting, and treating outbreak.
  • Ensure protocol is a collaborative effort with members of the medical staff including local acute care hospitals and is based on national guidelines such as CDC guidance.
  • Review all advance directives and have a conversation before a crisis happens.
  • Ensure there are specific staff, equipment, and unit space available to cohort and care for residents who are both symptomatic and asymptomatic.
  • Ensure there are clear lines of communication with local and state health departments.
  • Ensure there are connections in place with critical vendors including but not limited to
  • access to PPE, medications, testing, food, nursing supplies, fuel, transportation, emergency services.
  • Ensure up-to-date phone numbers and e-mail addresses for staff and resident families.
  • Ensure clear communication methods are in place with key partners including residents, staff, and family members.
  • Educate families on what is and what is not a crisis. Talking to individuals directly vs. e-mails is helpful.
  • Ensure partnership agreements are in place with staffing agencies to allow for adequate staffing.
  • Ensure technology resources are available such as Zoom capabilities and the ability to FaceTime.
  • It is critical to move quickly but deliberately to ensure outbreak is contained.
  • Ensure handwashing and other sanitation procedures are done correctly.
  • Ensure staff have appropriate PPE and the knowledge to properly don and doff equipment.
  • Ensure regular in-servicing of staff and residents takes place to review infection control and other protocols.
  • Review competency of staff, including for cleaning procedures, which is critical.
  • Ensure constant review of best practices, access to latest research, and implementation of protocols.
  • Ensure methods in place to enhance resident and staff morale and to address mental health issues/concerns.
  • Provide opportunities for compassionate care visits, especially at the end-of-life.
  • Ensure methods are in place for admissions if possible, especially if families do not have access to help orient their loved one to the facility.
  • Ensure there are plans in place to address future possible outbreaks.
  • Ongoing vigilance is critical.

Key Considerations in an Emergency Health Outbreak

Strengthen emergency response capacity

Strengthen the ability to plan, coordinate and execute effective responses to the emergency and potential surges

Stabilize Facility and Bolster Workforce

Increase the responsibilities of and support for our facility and our employees in the short and longer-term

Increase Transparency and Accountability

Implement stronger mechanisms to ensure a greater degree of accountability and increase transparency through data and reporting

Be More Resilient

Implement internal structures for stronger collaboration including increasing reliance on home- and community-based services (HCBS).

COVID-19 and the Future in Our Facility

In order to “reopen” our facility and resume normal operations, we must prepare all the required critical steps to fully prepare for a possible second wave and/or isolated outbreaks and protect residents and staff to the fullest extent possible.

Emerson employees are essential to our facility. You are all our most valuable resource. You all deserve our utmost appreciation for what you do every single day and especially in these unprecedented times. We wholeheartedly thank you for your tireless dedication. You are our healthcare heroes.