The virus is transmitted through droplets from an infected person who coughs or sneezes. These droplets can land in the mouth or nose of people who are nearby (within 6 feet) or possibly be inhaled through the lungs. It is also possible for the virus to spread if a person touches a surface or object that has the virus on it, and then touches their own mouth, nose or eyes. There are some instances where the droplets can be aerosolized through treatments like nebulizers and CPR.

days after exposure to the virus. The CDC reports that symptoms of COVID-19 include cough, shortness of breath, fever, chills, muscle pain, headache, sore throat or loss of taste or smell. https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html

Presentation of COVID-19 in skilled nursing facility residents may be more subtle, so preemptive isolation and testing is recommended for any resident with unstable vital signs or significant change of medical condition, including gastrointestinal symptoms, weakness, dizziness, altered mental status, or low grade fever.

Current research has demonstrated that patients infected with COVID-19 will develop antibodies to the virus. We are hopeful that these antibodies will protect someone from reinfection but this is still an unknown.

We are watching the medical literature very closely for reports of patients becoming infected by COVID-19 more than once. At this point, our assessment is that recurrent infections are either extremely rare or do not occur. The reports we have seen in the literature comment on repeat positive RNA tests, but do not describe recurrent infections.

Masks function to block virus from entering the mouth and nose. The mask should be considered dirty at all times. Placing the mask under the chin or on the head to eat or breathe more easily will result in contamination of the chin and head.

Yes, glasses are not considered personal protective equipment and therefore goggles or eye shields are required when transmission based precautions are required.

Yes, PPE should be removed and hand hygiene performed. Please inform your staff not to eat or drink on the unit where they work.

Expert Stewardship recommends that used gowns be discarded (disposable) or laundered (washable) after every use. Re-use of disposable gowns has been suggested in situations of extreme shortages or in circumstances where there are large outbreaks in a unit. If there is a PPE shortage crisis, contact Orange County Health Care Agency. However, Expert Stewardship remains concerned about the potential for contamination of HCW from this practice. In sub-acute units, gowns should be changed after each resident contact. When dealing with residents co-infected with significant pathogens e.g., Clostridioides difficile or Candida auris or CRE, gowns need to be changed after each resident contact.

In our attempts to conserve gowns, HCWs can be advised to wear their gowns while attending to multiple residents. As an example, if an HCW is caring for 3 residents in a room, each resident being COVID positive, they can wear the same gown while caring for all three residents. Within a dedicated COVID unit with all residents COVID positive, the same HCW can continue to wear the gown from room to room to continue care for residents.

If residents are co-infected with other significant pathogens like active diarrhea with Clostridioides difficile, then a new gown needs to be donned.

Yes, it is advisable to keep the COVID positive residents’ door closed.

If a facility chooses to have their staff wear scrubs when caring for COVID positive residents, the staff must still don a gown, which is PPE. Scrubs are not considered nor do they count as PPEs.

No, double-masking is not recommended since it increases the chances that you will self-contaminate. Additionally, it is also a waste of PPE resources which provides no additional benefit. It is far more important to avoid touching your mask while it is on your face. If you must touch your mask, e.g., your mask needs adjusting, then you must clean your hands immediately before and after touching your mask.

Waste emanating from a COVID positive resident is not considered biohazardous and those items can be disposed of as regular waste. Red bagging is not needed.

Considering the fact that there is a shortage of gowns, visitors should not be required to wear gowns or gloves while in the facility. Laboratory or x-ray providers should wear gowns when working directly with the residents who are isolated.