Long-term Care Facilities and COVID

To notify Snohomish County Health Department of a positive case of COVID-19 within your facility please call 425-339-5278 during business hours (Monday through Friday 8 a.m. – 5 p.m.).

You can also send an email to shd.ltc@co.snohomish.wa.us. Please do not send patient protected information. This email box can be used at any time. Staff will work with you to provide a secure portal if patient protected information is needed.

General Information

What steps should our facility take to prepare for COVID?

The Centers for Disease Control and Prevention have published comprehensive guidelines for preparing for COVID.
The Centers for Disease Control and Prevention have published an assessment tool for preparing for COVID. If you are interested in an in-person or video Infection Control Assessment and Response (ICAR), please email shd.ltc@co.snohomish.wa.us with the subject line “ICAR Request – (Name of Facility)”. In the body, please tell us your facility’s address, point-of-contact, and phone number.
The Centers for Medicare & Medicaid Services have issued the following:

How do we transfer a resident from our long-term care facility to another healthcare setting?

The Washington State Department of Health has released interim guidance.

What is considered an outbreak?

The Washington State Department of Health has aligned their outbreak definition with CSTE, which now defines an outbreak in long-term care as:…
- Although WA DOH is recommending the previous “outbreak definition”, we’ve been instructed to utilize the current definition as of 1/1/2023.
  - ≥1 facility-acquired COVID-19 case in a resident
  - ≥3 suspect, probable or confirmed COVID-19 case in HCP with epi-linkage AND no other more likely sources of exposure for at least 1 of the cases

We had an employee test positive at our healthcare facility. What guidance should we follow?

The Centers for Disease Control and Prevention have outlined criteria for return to work for healthcare personnel.

We had a resident test positive. What guidance should we follow?

For residents who have tested positive, they should do the following:
1. Isolate away from others for at least 10 days, or 24 hours after their symptoms improve and fever resolves without the use of fever-reducing medications, whichever is longer
2. Resident should be placed in a single-person room, or cohort with residents who have the same infection
3. Signs should be placed outside of the resident's room to notify anyone entering of the need to wear additional PPE.
4. Healthcare workers should perform hand hygiene when entering and exiting the room, wear a face mask, eye protection, and gown and gloves during resident contact
5. Identify other residents that may have been exposed (such as roommates) and follow the guidance for residents exposed (in the question below)
The Centers for Disease Control and Prevention have issued interim clinical guidance for management of patients with confirmed COVID-19.

we had a resident with known/suspected exposure to COVID. What guidance should we follow?

Resident Quarantine is no longer based on vaccination status but rather:
- Patients with an exposure to SARS-CoV-2 need to be placed in TBP for quarantine if they meet one of the following criteria:
  - Patient is unable to be tested or wear source control as recommended for the 10 days following their exposure
  - Patient is moderately to severely immunocompromised
  - Patient is residing on a unit with others who are moderately to severely immunocompromised
  - Patient is residing on a unit experiencing ongoing SARS-CoV-2 transmission that is not controlled with initial intervention.
Anyone who had prolonged close contact (within 6 feet for at least 15 minutes) should be considered potentially exposed (WA DOH). This could refer to a single 15-minute exposure to one infected individual or several briefer exposures to one or more infected individuals adding up to at least 15 minutes during a 24-hour period. However, the presence of extenuating factors (e.g., exposure in a confined space, performance of aerosol-generating procedure) could warrant more aggressive actions even if the cumulative duration is less than 15 minutes. For example, any duration should be considered prolonged if the exposure occurred during performance of an aerosol generating procedure. (CDC)

We have a resident that receives an aerosol-generating procedure. What should we do?

Aerosol Generating Procedure Sign (Washington State Dept. of Health)
Precautions During and Following Aerosol Generating and Other Procedures

We had a resident leave the facility, do they need to be quarantined?

Residents that leave the facility for over 24 hours should be managed as an admission. (WA DOH)
Admissions to SNFs in counties where Community Transmission levels are high should be tested upon admission; admission testing at lower levels of Community Transmission is at the discretion of the facility.
Admissions should be advised to wear source control for 10 days following their admission.
For admission with confirmed or suspect SARS-CoV-2 infection or exposure, refer to DOH Guidance on isolation and quarantine.

Reporting to Snohomish County Health Department

The Health Department uses the Washington State Department of Health’s online reporting tool, called the Facility Outbreak Notification Tool (FONT) for Healthcare Settings, for facilities to report cases of COVID-19.

Reporting using this website is HIPAA compliant and can be completed on a mobile device (such as a phone or tablet) or on a computer
Facilities can upload a line list or enter information directly into the webpage
- If facilities are reporting additional cases, they do not need to re-report cases that have already been reported to the Health Department

To report an outbreak of influenza or gastrointestinal illness, please call 425-339-3503 rather than using the FONT tool.

Personal Protective Equipment

How do I order?

The Health Department may be able to help you find personal protective equipment. For ordering instructions, click here.

What should we use?

The Centers for Disease Control and Prevention have outlined guidance on using personal protective equipment.

What is the proper way to use PPE?

The Centers for Disease Control and Prevention have created a tutorial on proper Donning of PPE.
The Centers for Disease Control and Prevention have created a tutorial on proper Doffing of PPE.

COVID testing

Long-Term Care Facility Testing for Staff and Residents (WA Department of Health, February 2022)

I would like to test all of my residents, what do I need to do?

You will need to contract with a lab to accept your specimens
You will need to have an Ordering Physician. This is something your facility will need to hire/contract for. The Health Department is unable to help with this at this time.
You may need to apply for a CLIA Waiver.
1. Guidance for Waiver
2. Application
You will need to order testing supplies

Who is authorized to collect nasal swabs for COVID testing?

The Washington State Department of Health has provided the following chart that outlines which licensed healthcare provider can administer COVID-19 tests

Guidance from the Centers for Disease Control related to testing

Department of Social and Health Services

Where can I find Dear Provider letters?

ALTSA Provider/Administrator Letters

Long-Term Care COVID Response Plan(formerly the Safe Start for Long-Term Care Plan)

Beginning February 23, 2022 the Safe Start for LTC will change to a LTC COVID Response document with recommendations that providers follow CDC, DOH, and, if applicable CMS guidance. Visitation recommendations will also change to align with this guidance and will open visitation in LTC facilities and homes. Providers will still need to work with the local health jurisdiction regarding specific visitation restrictions in the event of an outbreak.