DHS Encourages Long-Term Care Facilities to Plan for Potential Outbreaks

This information is provided by the Wisconsin Department of Health Services (DHS).

Wisconsin continues to see a high number of viruses circulating, including COVID-19, respiratory syncytial virus (RSV), influenza, and norovirus. DHS encourages Wisconsin long-term care facilities (LTCFs) to be prepared for potential outbreaks, which can arise and spread quickly in this population.

During this time of high viral activity, taking proactive steps to prepare for and manage outbreaks in your facility is critical. Promote staying up to date with vaccinations, including the bivalent COVID-19 booster dose, to facility staff, residents, and visitors. The following are additional considerations facilities can take to keep residents and staff safe and healthy.

Increase disease surveillance

Conduct symptom screening of residents, staff, and visitors. Early identification of symptoms will allow facilities to take appropriate actions in a timely manner and limit the spread of infectious disease. Residents who are experiencing symptoms should promptly be placed on transmission-based precautions while the infection is identified or ruled out. Residents in transmission-based precautions should be restricted to their room and be excluded from participating in group activities. Symptomatic staff should be excluded from work and follow facility employee health return to work policies. Ensure that staff who are not directly employed by the health care facility, but provide services, are also aware of the facility employee health policies. Visitors should be encouraged to stay home and not visit the facility while experiencing symptoms of any kind.  

Perform testing as indicated

Facilities should have adequate testing supplies on hand and testing protocols in place. Staff should be educated on specimen collection techniques for different communicable diseases.

Continue to prioritize COVID-19 testing for staff and residents experiencing respiratory symptoms. COVID-19 testing supplies are available through the state. If test results are negative for COVID-19, consider additional testing for other respiratory viruses with an acute respiratory illness (ARI) panel. Wisconsin LTCFs can contact the Division of Public Health (DPH) for approval to send specimens to the Wisconsin State Laboratory of Hygiene (WSLH) for testing free of charge. 

Testing for individuals experiencing symptoms consistent with gastrointestinal illness, such as norovirus, is also available through WSLH. Facilities are encouraged to work with their local or Tribal health department (LTHD) if outbreaks are suspected. 

Manage PPE supplies proactively

Facilities should have a sufficient quantity of personal protective equipment (PPE) on hand (including gowns, gloves, eye protection, masks, and N95 respirators) at all times to safely respond to an outbreak. Facilities should not rely on the LTHD or other local health care facilities to provide PPE if the LTCF is short on supply. Understanding your facility’s PPE burn rate, or the rate at which your facility uses PPE, can be helpful in ensuring you have enough PPE on hand. 

As you wait for the infectious agent causing the outbreak to be identified, it’s recommended that health care personnel empirically follow the most stringent PPE guidelines to avoid exposure. This includes wearing gloves, a gown, eye protection, and a fit tested N95 respirator for suspected SARS-CoV-2. Once the infectious agent is identified, appropriate PPE for that agent should be used.

Your facility may request PPE from the DHS Stockpile if you are unable to secure sufficient PPE from a vendor or will not have enough while waiting for additional PPE to to be delivered. To request from the DHS Stockpile: 

1. Download and complete the DHS Stockpile Request form.
2. Email the completed form to dhsstockpile@dhs.wisconsin.gov.
3. Participate in a consultation call from DHS to discuss your request.

Stock up on other supplies

Facilities are encouraged to have adequate supplies of other products that may be needed during an outbreak available as well, including dedicated resident equipment, cleaning and disinfection products that are effective for the types of viruses circulating, alcohol-based hand sanitizer, and enough accessible trash cans to manage disposal of additional PPE.   

Stay informed on treatment options for residents

Residents who test positive for COVID-19 may benefit from oral antivirals which have been shown to reduce the risk of hospitalization and death. LTCF medical providers who need assistance prescribing these medications may contact the DHS COVID-19 Telehealth Treatment hotline. The telehealth treatment service will connect LTCF providers and their residents with a licensed clinician who can discuss prescribing indications, side effects, and management of drug-drug interactions.

To consult with a telehealth clinician about COVID-19 oral antiviral prescribing, LTCF medical providers should call the telehealth hotline at 833-273-6330. The resident being considered for treatment must be able to consent to the telehealth consultation. When calling, please be ready to provide the resident's current medications, medical history, and recent serum creatinine if there is known or suspected renal impairment.

For guidance on prioritizing antiviral treatments for influenza, see DHS Health Alert Message 53: Interim Guidance for Clinicians to Prioritize Antiviral Treatment of Influenza in the Setting of Reduced Availability of Oseltamivir.

Additional resources

Wisconsin Department of Health Services resources

For more information on preventing and controlling acute respiratory illness outbreaks in LTCFs, review the recent DHS Spread of Multiple Respiratory Viruses in Wisconsin Long-Term Care Facilities listserv message. Guidance is also available on the DHS Preventing and Controlling Respiratory Illness Outbreaks in Long-Term Care Facilities webpage, which replaces the DPH memo formerly distributed annually. The Healthcare-Associated Infections Prevention Program will also review this webpage on the January Long-Term Care Education Series call on January 26 from 10:30 a.m. – 12 p.m.

For recommendations and guidance on acute gastroenteritis outbreaks, refer to the DHS Prevention and Control Recommendations for Acute Gastroenteritis Outbreaks in Wisconsin Long-Term Care Facilities guidance document.

Centers for Disease Control and Prevention (CDC) resources: 

• Appendix A, Isolation Precautions
• Core Infection Prevention and Control Practices for Safe Healthcare Delivery in All Settings
• Interim Guidance for Influenza Outbreak Management in Long-Term Care and Post-Acute Care Facilities
• Testing and Management Considerations for Nursing Home Residents with Acute Respiratory Illness Symptoms when SARS-CoV-2 and Influenza Viruses are Co-circulating

Questions?

For questions and additional outbreak assistance, reach out to the HAI Prevention Program at DHSWIHAIPreventionProgram@dhs.wisconsin.gov or your Regional Infection Preventionist.