Greetings from Marin County Public Health Outbreak Prevention and Infection Control (OPIC) Team. Our mission is to provide support to healthcare and congregate care facilities as you mitigate and manage risks due to communicable diseases and emergencies by promoting high levels of readiness, ensuring effective responses, and providing trainings and educational opportunities.
Guidance Updates
MASKING, SCREENING, TESTING, ISOLATION AND QUARANTINE, VISITATION, AND INFECTION CONTROL REQUIREMENTS: CDSS Guidance PIN 23-07 (updated 4/6/2023). This guidance instructs Adult and Senior Care (ASC) facilities to implement new practices for COVID-19 mitigation. From the date of this PIN, residents in ASC facilities may follow Community Guidelines on Isolation for COVID-19. Residents will isolate for 5 days and return to usual activities if they are symptomatically recovered and fever free for >24 hours. Testing is not required but may be used to enhance safety when discontinuing isolation. In congregate settings, in the absence of additional measures it is highly likely that Covid will spread without further interventions. Therefore: Residents recovering from Covid should mask for another 5 days following isolation or until 10 days following a positive test or symptom onset. We recommend that exposed residents test twice weekly until 10 days following their last known exposure. Mask use by all residents is strongly recommended during an outbreak.
Vaccine Requirements at Long Term Care Facilities
Federal regulations 42 CFR 483.80(d)(3) and 42 CFR 483.460(a)(4)(i) also require that Long-Term Care (LTC) facilities and Intermediate Care Facilities (ICFs) for Individuals with Intellectual Disabilities (ICFs-IID) must offer COVID-19 vaccines to residents, clients, and staff onsite (incl. bivalent boosters). CMS certified facilities are required to follow QSO-23-02-ALL Oct. 26, 2022 which instructs that all staff are required to receive the COVID-19 primary series of vaccination.
Vaccine Data Collection
Recently enacted legislation (AB 1797) requires California healthcare providers who administer vaccines to enter information about patients, including telephone numbers and race and ethnicity.
Health Care Settings Guidance Updates and Resources
Most of our LTC facilities do not have Airborne Infection Isolation Rooms (AIIR) / negative pressure rooms. SARS CoV2 is an aerosol pathogen per CA Regulation Title 8 Section 5199. Specific exemptions apply when caring for persons with COVID-19. Application of Exceptions requires careful and regular documentation. Many of our Marin County buildings have older or non-compliant ventilation systems. In these cases you must implement and document specific accommodations when caring for COVID-19 Positive persons (persons with Novel Respiratory Pathogens or Airborne Infectious Pathogen-AirIP). This may include assessment of ventilation, use of in-room HEPA filters, exhaust ventilation via window when done per regulation, and of course proper respiratory precautions for all staff and visitors entering such areas. Additional resource Cal/OSHA - COVID-19 Non-Emergency Regulations FAQs
See also section (d) (2) (E) of 5199: “Specific control measures shall be listed for each operation or work area in which occupational exposure occurs. These measures shall include applicable engineering and work practice controls, cleaning and decontamination procedures, and personal protective equipment and respiratory protection.” This would be included in your Aerosol Transmissible Disease Plan per Section 5199.
When caring for persons with COVID-19 (Air-IP) in Non-Airborne Infection Isolation Room (AIIR) settings (i.e. when not in negative pressure rooms) you are operating under Section 5199 EXCEPTIONS to Subsections (e)( 5) (B). In most instances this will be under Exception #2: “Where it is not feasible to provide [Airborne Infection Isolation - AII] rooms or areas to individuals suspected or confirmed to be infected with or carriers of novel or unknown ATP (aerosol transmissible pathogen).” In this case, “employer shall provide other effective control measures to reduce the risk of transmission to employees, which shall include the use of respiratory protection in accordance with subsection (g) and Section 5144, Respiratory Protection of these orders.” This includes putting into place specific protections. NOTE: Exceptions do not apply for when high risk procedures are performed such as intubation; in such cases AIIR or use of PAPR as additional measures are recommended.
Ventilation: Refer to CA Regulation 3205.1 COVID-19 Outbreaks section (f): (f) Ventilation. In buildings or structures with mechanical ventilation, employers shall filter recirculated air with Minimum Efficiency Reporting Value (MERV)-13 or higher efficiency filters if compatible with the ventilation system. If MERV-13 or higher filters are not compatible with the ventilation system, employers shall use filters with the highest compatible filtering efficiency. The employer shall use High Efficiency Particulate Air (HEPA) air filtration units in accordance with manufacturers' recommendations in indoor areas occupied by employees for extended periods, where ventilation is inadequate to reduce the risk of COVID-19 transmission.
MCPH and Early Alert Canines are visiting SNFs. See them in action in this video.
We are providing monthly newsletters to provide updates from Marin County Public Health in terms of guidance, status updates, and trainings. These newsletters will be sent mid month, and our Ombudsman meetings will be held the fourth Tuesday of each month at 2 PM.
Please contact Dan Steckline to be added to those meeting invitations (DSteckline@marincounty.org). Next Ombudsman meeting is: Tuesday, April 25 2:00-3:00 PM
