by Dr. Molly O’Dell
We have received many questions about our efforts to mitigate the spread of COVID-19 in long term care facilities (LTCFs). These facilities represent a combination of two high-risk populations: individuals in a congregate living facility, and older adults, who are at highest risk for severe illness. This pandemic brought on an entirely new set of circumstances for most facilities. It was very important to our team to provide extra support to these facilities, and we have done so throughout the COVID-19 pandemic.
Early on, our team reached out proactively to all of our area LTCFs to conduct a survey, analyzing their level of preparedness, access to personal protective equipment (PPE) and other medical supplies, their capacity for FIT testing N95 respirators, and their protocols for Infection Prevention and Control (IPC). We established relationships, provided guidance, and identified several resources that we were well-positioned to support them with.
One of our biggest challenges was the demand for PPE. Not only were N95 respirators in demand, so were the other items that are used to effectively protect against COVID-19: gowns, face shields or eye goggles, and gloves. Our LTCFs were reporting significant challenges keeping these supplies in stock. The Near Southwest Preparedness Alliance (NSPA) is a coalition designed to support healthcare organizations through disasters. NSPA, in partnership with our team, has distributed over 116,000 pieces of PPE to LTCFs and other healthcare organizations.
Our public health nurses and epidemiologists worked as a point of contact to help LTCFs ensure that their medical staff were appropriately fitted for their N95 respirators. N95 respirators are a key strategy of an infection prevention and control policy to address a contagious respiratory illness. It is necessary to be fitted for these products to ensure that they function properly, keeping particles from escaping and potentially infecting others. Our staff would train a few key staff from the LTCFs and provide the supplies for FIT testing, allowing the LTCFs to FIT test their entire staff.
Our team also responds to outbreaks in LTCFs. For initial outbreaks, our nurses provided point prevalence testing, which is a process of testing the entire facility – staff and residents. In 14 outbreaks in local LTCFs, we have seen about 325 cases from staff and patients. This represents approximately 9% of our overall cases. We coordinate with public testing labs to process these results quickly – either the state lab in Richmond, or the lab at Virginia Tech. Testing is always accompanied by case investigations and contact tracing. In addition, our nursing and epidemiological team supported the facilities with guidance on policy and practices for infection prevention and control.
Our epidemiological team reviewed the policies and protocols of LTCFs to ensure they were in alignment with CDC and VDH’s guidance to keep staff and residents safe. These include but are not limited to the facility having a testing plan in place, an infection prevention and control plan is in place and a respiratory protection program is in place.
As the situation continues to change, we will keep working with our LTCF partners and the Near Southwest Preparedness Alliance to ensure they have the resources and education they need to be able to care well for our loved ones.
Dr. Molly O’Dell is Director of Communicable Diseases for the Roanoke City and Alleghany Health Districts
