PANDEMIC EMERGENCY PLAN

WESTCHESTER DIVISION

As an organization that houses potentially fragile population, The New Jewish Home wants to ensure that all residents/patients staff, family members, vendors, and volunteers are protected when in or entering the facility. An effective healthcare response to a pandemic event requires an overall awareness of the facilities capabilities to handle the event.

The organization is being proactive in regards to all events including, Natural Hazards, Technological Hazards, Human Hazards and Hazardous Materials will include the four phases of an effective Emergency Plan, Mitigation, Preparedness, Response and Recovery in developing the Pandemic Emergency Plan.

Also included in the preparing of our policies and procedures the facility will conduct a Hazard Vulnerability Analysis to determine which will determine the types of disasters that are likely to affect the organization. The HVA will be prepared annually or as needed.

The Hazard Vulnerability Analysis developed is for both facility and community- based events.

A multidisciplinary team has been created to specifically address pandemic preparedness planning. The team consist s of the following:

• Medical Director
• Administrator
• Assistant Administrator
• Nursing
• Human Resources
• Material Management
• Pharmacy
• Environmental Services
• Plant Operations
• Infection Control
• Food/Nutrition
• Public Affairs
• Security
• Information Technology

The organization conducts on going employee education on the definitions of COVID 19, its symptoms and precautionary measures.

UNDERSTANDING COVID-19

Frequently Asked Questions

What is Coronavirus?

According to the World Health Organization (WHO), Coronaviruses are a large family of viruses which may cause illness in animals or humans. In humans, several coronaviruses are known to cause respiratory infections ranging from the common cold to more severe diseases.

What is COVID-19?

COVID-19 is the infectious disease caused by the most recently discovered coronavirus. This new virus and disease were unknown before the outbreak began in Wuhan, China, in December 2019.

What are the common symptoms of COVID-19?

• Fever
• Cough
• Body Ache
• Fatigue
• Runny Nose
• Congestion
• Headache
• Eye pain and/or ear pain/irritation
• Conjunctivitis
• Loss of taste and/or smell
• Nausea
• Vomiting
• Diarrhea

How is COVID-19 spread?

The virus that causes COVID-19 is thought to spread mainly from person to person, mainly through respiratory droplets produced when an infected person coughs or sneezes. The droplets can land in the mouth or noses of people who are nearby or possibly be inhaled into the lungs.

Spread is more likely when people are in close contact with one another (within about six feet). The virus can also be spread via surfaces, in addition to person to person spread.

What to do if a resident is diagnosed with COVID-19 in the facility?

Ideally, a resident/patient with COVID-19 should be in a separate room with a dedicated bathroom. The resident should remain in the room for all activities including meals. If a resident must leave the room for medical service staff must place a face mask and cover the resident/patient with clean sheets.

The facility must conduct contact tracing, to attempt to identify others who did not wear appropriate PPE were in close contact with the patient.

The facility will quarantine the exposed patient for 14 days and monitor for fever and respiratory symptoms.

What to do if a staff member is diagnosed with COVID-19?

As soon as the infected staff person is identified, they should leave work immediately and quarantine themselves. They should be out 14 days from their test date and return after a negative test result.

PREVENTION

Prevention at Work

The facility is screening all employees/vendors/consultants as they enter the facility to the start of their shift. Test all employees/vendors/consultants weekly. Those who refuse to be tested cannot work in the facility.

List of symptoms to monitor:

• Fever (an elevated temperature higher than 100 degrees)
• Cough
• Body aches
• Fatigue
• Runny Nose
• Congestion
• Headache
• Eye pain and/or ear pain/irritation
• Conjunctivitis
• Loss of taste and /or smell
• Nausea
• Vomiting
• Diarrhea

If the staff person is experiencing any of the above symptoms, he/she should:

• Immediately notify supervisor
• Not enter the building
• Return home
• Seek medical attention

The facility will immediately:

• Screen all workers prior to the start of their shift.

HAND WASHING (Hand Hygiene)

All employees should always complete hand hygiene:

• Before and after ALL patients encounters.
• Before putting on and after removing personal protective equipment (PPE).
• Should also use hand hygiene at the beginning and throughout their shift.
• Before and after eating.
• After using restrooms.
• Make sure hand hygiene supplies, such as soap and water or alcohol-based hand sanitizer, are readily accessible in-patient care areas, including areas where staff remove PPE.
• Sinks need to be well stocked with soap and paper towels and hand sanitizers, and should be replaced as needed.
• Employees should always use proper hand hygiene and wash with hot water and soap for at least 20 seconds.

RECOMMENDED HAND HYGIENE PRACTICES

1. Wet hands with hot water.
2. Apply enough soap to cover all hand surfaces.
3. Rub hands palm to palm.
4. Right hand over left with interlaced fingers and vice versa.
5. Palm to palm with fingers interlaced.
6. Back of fingers to opposing palms with fingers interlocked.
7. Rotational rubbing of left thumb clasped in the right palm and vice versa.
8. Rinse hands with water.
9. Dry thoroughly with a single use towel.
10. Use towel to turn off faucet.

PERSONAL PROTECTIVE EQUIPMENT (PPE)

Use and reuse of PPE

Surgical Masks — This should be changed:

• If it is dirty
• Has fluid splashes
• If it is difficult to breathe
• At least once a day
• Staff will follow facility protocols for PPE usage and re-usage.

KN-95 Mask-A KN-95 mask can be reused.

• N-95 masks will be distributed, stored and reused as per the facility N-95 reuse policy.

Face-Shields

• Wear face-shields completely covering your face, eyes, and masks.
• They are reusable for several days/weeks, until it is damaged.
• Staff will clean and disinfect after each use.
• It is always important to wear a face shield.
• Staff are responsible to maintain and store face shield as per facility policy.

Gowns

• If gowns are required to be used in your area, they can be reused with different patients for the entire shift, unless it is visibly soiled, has fluid splashes, or if the patient has another infectious disease.

Gloves

• Staff person must wear gloves during all patient care.
• Staff person must change gloves after each patient encounter.

Head Covers

• If head covers are required in your area, it can be worn for the entire shift. 

All medical supplies and equipment are managed by the Materials Management/Central Supply staff. They manage the inventory and work with the Vice President of Materials for ordering supplies and maintaining arrangements with vendors. They will ensure that the facility will maintain a 60-day supply of PPE throughout the facility

STAFF WHO DON’T PERFORM DIRECT CARE

• Wash your hands frequently, or use alcohol gel.
• Clean high touch surfaces with bleach and/or quaternary disinfectant.
• Disposal PPE should be placed in regular trash containers, do not use red bags

PATIENT CLOTHING AND BELONGINGS

Gloves must be worn when handling potentially contaminated laundry.

• Items should be washed separately, in the warmest appropriate temperature and dry them completely
• Hands should be washed after doing laundry.
• Clothing should be kept separate, until washed.

PATIENT ROOMS

Visitors:

• Visitors are prohibited from entering facility unless essential.
• All family members visiting end of life patients should be wearing full PPE throughout the visit.
• Ascertain and post signs instructing visitors not to enter if they are not well.
• Set-up alternative methods of visitation such as videoconferencing.
• If visitors are permitted, monitor for fever and respiratory symptoms.
• Limit the duration of the visitation and the location of visits in resident rooms.

ROOMING GUIDELINES

If COVID-19 is suspected, based on evaluation of the resident or prevalence of COVID-19 in the community:

• Residents with known or suspected COVID-19 do not need to be placed into airborne infection isolation room but should ideally be placed in a private room with their own bathroom.
• Room sharing might be necessary if there are multiple residents with known or suspected COVID-19 in the facility. As roommates of symptomatic residents might already be exposed, it is generally not recommended to separate them in this scenario. The Department of Health can assist with decisions regarding resident placement.

FOOD & NUTRITION

Although coronaviruses appear to be stable at low and freezing temperatures for a certain period of time, good food safety practices can prevent their spread through food.

Food service workers should:

• Not enter patients’ rooms.
• Wear face coverings and gloves when preparing, serving or delivering food to outside resident rooms.
• Employees must wash hands frequently.
• The Director, Food/Nutrition is responsible for staff to follow all policies and procedures regarding PPE.

ENVIRONMENTAL SERVICES

• The facility has a plan in place to ensure proper cleaning and disinfection of environmental services (including high touch services such as light switches, bed rails and bedside tables, etc.) and equipment in the resident room.
• All staff with cleaning responsibilities must wear proper PPE when cleaning all areas and must understand the contact time for cleaning and disinfection products used in the facility. (Staff must check containers for specific guidelines.)
• Ensure shared or non-dedicated equipment is cleaned and disinfected after use according to the manufacturer’s recommendations.
• The facility set a protocol to clean rooms after a patient is discharged from the facility.
• If a known COVID-19 is discharged or transferred, staff will not clean the room until sufficient time has elapsed for enough air exchange to take place.
• The Director of Housekeeping is responsible for workers to follow all policies and procedures.

MEDICAL EQUIPMENT

All medical equipment in the facility will be constantly inspected, tested and maintained according to the manufacturer’s recommendation.

GDC is the contractor used by the organization is responsible for inspecting, testing and maintained of medical equipment.

The Director, Plant Operations oversees the work being done by the contractor.

SAFETY AND SECURITY

The Safety and Security department will maintain a safe and secure environment in regards to pedestrian movement in and out of the facility. The officer assigned to the entrance will advise all visitors of the restricted communities and remind them to use hand hygiene materials.

The security officer assigned to the main entrance will take temperatures and distribute the screening checklist for staff to complete.

CONTRACTORS & OUTSIDE VENDORS

Contractors and outside Vendors should not regularly enter the facility. Designated staff will meet the individual at the door and have all follow CDC guidelines temperature taken etc.

PLANT OPERATIONS

The Director of Plant Operations will be responsible to maintain a comfortable environment to residents/patients, staff, family members, visitors and volunteers.

The Director will also be responsible to maintain all filters and change when necessary.

THERAPEUTIC RECREATION

The TR Department will attempt to provide normal functions for residents as possible. The department will also be responsible to facilitate face time calls.

DEPARTMENT OF RELIGIOUS LIFE

The religious life staff will provide pastoral counseling as appropriate for residents, staff and family members. They will also lead and/or coordinate religious services when possible. Outside clergy will be able to visit people at end of life when possible.

CARE FOR THE CAREGIVERS

During periods of stress, caregivers may fail to request support for many reasons a strong service-orientation, a lack of time, difficulties in acknowledging or recognizing their own needs. Given this, the organization will be proactive in encouraging supportive care. The facility has in place to contact the Employee Assistance Program.

Self-care for health-care workers can be complex and challenging, given that people in these roles may prioritize the needs of others over their own needs.

For instance, during work shifts, workers should engage in the following:

• Self-monitoring and pacing
• Regular check-ins with colleagues, family and friends
• Working in partnerships and teams
• Brief relaxation/stress management breaks
• Regular peer consultation
• Time-outs for basic bodily care and refreshments
• Seek out accurate information

TRAINING

Members of the Environment of Care and Emergency Preparedness Committee will conduct Table Top Exercises to review and make necessary changes prior, during and post pandemic.

STAFFING

The Director of Human Resources will maintain an updated staff roster that includes staff, contact number, emergency contact, and what other facilities they work at.

INCIDENT COMMAND STRUCTURE

The facility will utilize its ICS and designate an Incident Command Center and Incident Commander.

Tier 1 – Administrator

Tier 2 – Assistant Administrator

Off shifts and weekends-Nursing Supervisor

All Job Action Sheets that are located in the CEMP will be taken to the ICC.

The facility will have an incident framework at each site, including a crisis phone tree to help spread information quickly and effectively at the location to reduce anxiety and wrong information.

COMMITTEE MEETINGS

The facility will review all aspects of the pandemic at the Environment of Care and Emergency Preparedness Committee meetings. Policies and Procedures will be reviewed and changes will be made if necessary.

MORTUARY

In the event of a rise in deaths and the facilities morgue can- not handle the overflow an agreement has been made for a vendor to provide a refrigerated truck to be delivered. The truck will be placed adjacent to the loading dock.

CLINICAL RESOURCES SYSTEM

• Update authorized family members and guardians of residents infected with the pandemic infectious disease at least once daily and upon change in the resident’s condition.
• Update authorized family members and guardians once per week on the number of infections and deaths in the facility.
• A plan to provide all residents daily access to free remote videoconferencing, or similar communication methods with authorized family members and guardians.
• Required communications must be by electronic means or other method selected by authorized family members or guardians.

The New Jewish Home provides these services by either letter, 11 a.m. hot line telephone calls and or texts. Also, the medical team will be in contact with authorized family members or guardians.

INFECTION PROTECTION PLAN

The facility developed an Infection Protection Plan to protect residents/patients, staff, family members and volunteers

• A plan has been developed for readmission of residents back to the facility after hospitalization for the pandemic infections.
• The Admissions department will use normal policies and procedures regarding  bed hold.
• The plan will consider methods on how to reduce transmissions in the event there are only one or a few residents with the pandemic disease.
• Residents with the disease will be isolated to a portion of the unit or the entire unit.
• Signage will be placed throughout the area advising all that the particular area has resident/s with the infectious disease.
• Other residents will not be allowed on the unit. Staff will be vigilant of this issue.
• The facility has a 60 -day supply of PPE throughout the facility.
• The plan will address all PPE necessary for both residents and staff.

SUPPLIES MAINTAINED

1. N95 Respirators
2. Face Shields
3. Eye Protectors
4. Gowns/Isolation Gowns
5. Gloves
6. Masks
7. Sanitizer and Disinfections in accordance with current EPA guidelines

Requests for PPE and supplies must be made as follows:

• Supplies are available at all times and are delivered to units based on the status of the unit.  If additional supplies are needed, they can be requested through the nursing management team 24 hours a day.

COMMUNICABLE DISEASE REPORTING

NYSDOH has the responsibility for protecting public health and ensuring the safety of healthcare facilities.

Facility reporting is required to:

• Detect intra-facility outbreaks, geographic trends and identifying emergencies.
• Infectious disease
• This collection of outbreak data enables the NYSDOH to inform healthcare facilities of potential risks and preventative actions to mitigate outbreak.

The New Jewish Home complies with this directive by completing the daily HERDS Survey and the staff survey weekly for Nursing Homes. The Administrator/Designee is responsible to complete these documents.

WHAT MUST BE REPORTED

• Any outbreaks or significant increase in nosocomial infections
• A single case of reportable communicable disease or any unusual disease
• Any outbreaks of increased incidents due to infectious agents
• Intra-facility outbreaks of influenza, gastroenteritis, pneumonia and respiratory syncytial virus.
• Food borne outbreaks.
• Infections associated with contaminated medication, replacement fluids or commercial products.
• Single cases of health-care associated infections (Legionella, Measles virus
• Single case of active pulmonary or laryngeal tuberculosis in nursing home residents or employees.
• Closure of unit due to infections.

PREVENTION WHEN LEAVING THE WORKSITE

How to safely return home:

• Clothes should be changed as soon as you enter your home and placed in a hamper until washed.
• Hands should be washed

If a potential exposure occurred in the workplace:

• It is important to limit interaction with other family members and remain 6 feet apart. Ideally stay in separate bedrooms and use separate bathrooms.
• Take temperature twice per day and monitor respiratory symptoms for 14 days
• Frequently touched surfaces should be disinfected.

How to safely go from one job to another:

Ideally, staff should only work at one skilled nursing facility during COVID-19 activity. This will avoid potential introduction of disease from an impacted facility to another.

If working at a second location cannot be avoided, essential should:

• Change clothing before going to the second location. The clothing should be bagged and taken home to be laundered.
• Hands should be washed before leaving the first location and again when entering the second location.
• A different face mask or covering should be worn for the second location.