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Institutes of Higher Education

B73 COVID-19 - Procedural Guidance for DPH Staff



Non-Residential and Residential Congregate Settings: Institutes of Higher Education

REPORTING PROCEDURES

Outbreak Definitions:

Under Title 17, Section 2500, California Code of Regulations all suspected outbreaks are reportable.

IHE Non-Residential Congregate Settings

At least 3 laboratory-confirmed cases with symptomatic or asymptomatic COVID-19 infection within a 14-day period in a group* with members on campus who are epidemiologically linked, do not share a household, and are not a close contact of each other outside of the campus. Epidemiological links require cases to be present in the same setting during the same time period while infectious.

*Groups include persons that share common membership, e.g., social organization; athletic teams, sports and recreation clubs; academic cohort; workplace on campus.

IHE Residential Congregate Settings

At least 3 laboratory-confirmed cases with symptomatic or asymptomatic COVID-19 infection with onset within a 14-day period, who live within the same dwelling or multiple dwellings that share a common area.*

*Includes on- and off-campus residential settings where groups of IHE students or staff reside, e.g., campus housing, Greek organization residential housing

Epidemiologic Data for Outbreaks

  1. Create a line list that could include:
    1. Names of cases
    2. Dates of illness onset
    3. Age
    4. Recent illness among contacts and their symptoms
    5. Epi links to other cases (rooms, meetings, etc.)
    6. Last date at educational site
    7. Hospitalization status
    8. Results of laboratory tests
    9. Vaccination status
  2. Maintain surveillance for new cases until no new cases for at least 14 days.
  3. Create an epi-curve, by date of onset (see CDC Quick Learn Lesson: Create an Epi Curve for guidance). Only put those that meet the case definition on the epi-curve. (Optional)

CONTROL OF CASE, CONTACTS & CARRIERS

Investigation can be conducted over the phone.

The frequency of follow-up with the facility for outbreak updates will be at least weekly, but more frequently as needed and determined by the Outbreak Management Branch (OMB).

Complete COVID-19 Education Sector Outbreak Form at the conclusion of the investigation (See Report Forms)

Additional Guidance/Resources:

  • LA County COVID-19 Testing Strategy
  • LA County Test Results Guidance
  • LA County Responding to COVID-19 in the Workplace Guidance
  • LA County Reopening Protocol for Institutes of Higher Education
  • LA County Protocol for COVID-19 Exposure Management in Institutes of Higher Education
  • LA County Protocol for Management of Outbreaks of COVID-19 in Institutes of Higher Education
  • LA County Protocol for COVID-19 Exposure Management in Institutes of Higher Education
  • California Department of Public Health COVID-19 Industry Guidance: Institutes of Higher Education
  • CDC Considerations for Institutes of Higher Education Cases

Cases

Confirmed COVID-19: A patient with a positive SARS-CoV-2 viral (molecular or antigen) test.

Presumed COVID-19: A patient with clinically compatible symptoms of COVID-19 and no clear alternate diagnosis with/without exposure history.  This presumptive clinical diagnosis is used when the provider has a high index of suspicion that a patient has COVID-19.

Cases (IHE Employees/Staff)

  1. Instruct presumed and confirmed cases of COVID-19 to self-isolate. They should not return to the setting for at least 10 days after symptom onset and 24 hours after fever has resolved without the use of fever reducing medicines and symptoms have improved. For asymptomatic cases, the date of collection of the specimen positive for SARS-CoV-2 can be used in place of onset. See Home Isolation Instructions.
  2. If the employee came to work while ill, they should be separated from others with door closed, masked, and directed to go self-isolate immediately.
  3. Determine when the employee was first symptomatic and when they were tested.
  4. Refer presumed cases to their primary care provider to discuss testing options.
  5. Determine which days and shifts the employee was at the site while infectious.
  6. If employee has severe symptoms, call 9-1-1. Notify EMS and the receiving healthcare facility of possible exposures.
  7. Remind employer that hospitalized and fatal cases of work-related COVID-19 must be immediately reported to Cal-OSHA www.osha.gov/SLTC/covid-19/standards.html).
  8. Consider alternative work options like teleworking if employee is well enough to do so.
  9. Instruct employee to notify all other employers of their illness.
  10. Document confirmed cases and contacts of these cases in the COVID-19 Case and Contact Line List for the Education Sector (see Forms section).
  11. Close off areas used by cases and do not use these areas until after cleaning and disinfecting (see DPH cleaning and disinfection matrix). Open outside windows to increase air circulation in the areas and then begin cleaning and disinfecting. If more than 24 hours have passed since a COVID-19 case was on site, only cleaning is required (not disinfecting). Cleaning should include cleaning of frequently touched surfaces and objects. If disinfecting, use an EPA-registered disinfectant approved for emergency viral pathogens (see www.epa.gov/pesticide-registration/list-n-disinfectants-use-against-sars-cov-2).
  12. IHE administrators should work with Public Health to determine if short-term closure of the affected area(s) is needed to prevent the spread of COVID-19.
  13. Notify all employees of COVID-19 exposure at site while maintaining patient privacy, and reinforce prevention measures across the facility/site.
  14. Post a notification letter of outbreak at the entrance of the facility/site and community area.
  15. Issue a public notification regarding on-site exposures if unidentifiable employees, attendees, clients or customers may have been close contacts. Examples of a public notification include, but are not limited to, issuing a press release, using social media, and/or including information in communications released to the public and/or customer list.
  16. Do not require a healthcare provider’s note for employees who are sick with symptoms of COVID-19  to validate their illness or to return to work.
    1. Even if COVID-19 testing is negative, utilize the symptom-based clearance strategy in bullet 1 for return to work.
    2. Utilize return to work protocols for healthcare professionals (HCP) if the employee provides direct clinical care to patients. Refer to DPH Guidance for Monitoring Healthcare Personnel and CDC's Criteria for Return to Work for Healthcare Personnel with SARS-CoV-2 Infection (Interim Guidance).
    3. Restrict contact with vulnerable* persons until 14 days after onset.
    *Individuals vulnerable to severe illness related to COVID-19 include those who are age 65 and above, or with underlying medical conditions such as chronic lung disease or moderate to severe asthma, chronic heart disease, diabetes, end stage kidney or liver disease or weakened immune systems such as cancer patients, those on immunosuppressive therapy and HIV/AIDS.
Cases (IHE Student)
  1. Instruct students with presumed or confirmed COVID-19 to self-isolate. They should not return to the IHE site for at least 10 days after symptom onset and 24 hours after fever has resolved without the use of fever reducing medicines and symptoms have improved. For asymptomatic cases, the date of collection of the specimen positive for SARS-CoV-2 can be used in place of onset. See Home Isolation Instructions.
  2. If the student showed symptoms while on campus at IHE site, they should be separated from others, ideally in an outdoor isolation area, masked, and instructed to self-isolate immediately.
  3. Determine when the student was first symptomatic and when they were tested.
  4. Refer presumed cases to their primary care provider to discuss testing options.
  5. Determine which days the student was on campus at the IHE site while infectious.
  6. If student has severe symptoms, call 9-1-1. Notify EMS and the receiving healthcare facility of possible exposures.
  7. Document confirmed cases and contacts of these cases in the COVID-19 Case and Contact Line List for the Education Sector (see Report Forms section).
  8. Close off areas used by cases and do not use these areas until after cleaning and disinfecting (see DPH cleaning and disinfection matrix). Open outside doors and windows to increase air circulation in the areas and then begin cleaning and disinfecting. If more than 24 hours have passed since a COVID-19 case was on site, only cleaning is required (not disinfecting). Cleaning should include cleaning of frequently touched surfaces and objects. If disinfecting, use an EPA-registered disinfectant approved for emerging viral pathogens (see www.epa.gov/pesticide-registration/list-n-disinfectants-use-against-sars-cov-2).
  9. IHE administrators should work with Public Health to determine if short-term closure of the affected area(s) is needed to prevent the spread of COVID-19.
  10. Notify all staff and students of COVID-19 exposure at site while maintaining patient privacy, and reinforce prevention measures across the IHE site.
  11. Do not require a healthcare provider’s note for students to validate their illness or to return to the IHE. Refer to bullet 1 of this section regarding home isolation.
  12. Restrict contact with vulnerable* persons until 14 days after symptom onset.

    * Individuals vulnerable to severe illness related to COVID-19 include those who are age 65 and above, or with underlying medical conditions such as chronic lung disease or moderate to severe asthma, chronic heart disease, diabetes, end stage kidney or liver disease or weakened immune systems such as cancer patients, those on immunosuppressive therapy and HIV/AIDS.

Contacts

A contact is a person with exposure to a confirmed case of COVID-19 during the period from 48 hours before symptom onset until the case meets criteria for discontinuing home isolation (See Home Isolation Instructions). For asymptomatic cases, the date of collection of the specimen that was positive for SARS-CoV-2 can be used in place of symptom onset.

Exposures are defined as follows:

  1. Being within approximately 6 feet of a person with confirmed COVID-19 for a prolonged period of time (15 minutes or more over a 24-hour period);
  2. Having unprotected direct contact with infectious secretions or excretions of a person with confirmed COVID-19 (e.g., being coughed or sneezed on, sharing utensils or saliva, or providing care without using appropriate protective equipment). 
  3. All exposures will be reviewed by Public Health to assess which persons need to quarantine, including the possibility of quarantining individuals beyond named close contacts if exposures cannot be ruled out. Refer to the  Protocol for Exposure Management in Institutes of Higher Education for updates on quarantine requirements.

NOTE: Asymptomatic persons who are fully vaccinated OR have recovered from laboratory confirmed COVID-19 within the last 90 days AND who are a close contact to a confirmed case are not required to quarantine or test for COVID-19. However, they should monitor for symptoms of COVID-19 for 14 days following an exposure.

A person is considered fully vaccinated >2 weeks following the receipt of the second dose in a 2-dose series (Pfizer-BioNTech or Moderna) OR one dose of a single-dose vaccine (Johnson and Johnson/Janssen). This guidance can also be applied to COVID-19 vaccines that have been authorized for emergency use by the World Health Organization (e.g. AstraZeneca/Oxford). See WHO’s website for more information about WHO-authorized COVID-19 vaccines.

Quarantine Instructions for Contacts

  1. Contacts who are asymptomatic should be instructed to self-quarantine and monitor symptoms for 10 days after last exposure, even if they receive a negative test result during their quarantine period. If they remain asymptomatic, they are released from quarantine after Day 10 but must continue to monitor their health and strictly adhere to COVID-19 prevention precautions through Day 14. Exposures include contact that occurs during the period from 48 hours before symptom onset until the case meets criteria for discontinuing home isolation. See Home Quarantine Guidance.
  2. If quarantined contacts develop symptoms of COVID-19 , then they should begin self-isolation. See Home Isolation Instructions.
  3. Do not require a healthcare provider’s note for contacts under quarantine to validate their illness or to return to the IHE.

Contacts (Staff/Employee and Students)

  1. Identify all campus staff/employee and student contacts to confirmed cases of COVID-19.
  2. Instruct contacts to self-quarantine and monitor symptoms for 10 days after last exposure even if they receive a negative test result during their quarantine period. If they remain asymptomatic, they are released from quarantine after Day 10 but must continue to monitor their health and strictly adhere to COVID-19 prevention precautions through Day 14 (see above Quarantine Instructions for Contacts).
  3. Document the contacts on the COVID-19 Case and Contact Line List for the Education Sector and submit it to DPH as soon as possible.
  4. Instruct contacts to get tested as soon as possible, whether they have symptoms or not. Refer contacts to the campus health office or their primary care provider to discuss testing options and other testing resources if needed.
  5. Do not require a healthcare provider’s note for employees or students to return to IHE.
  6. Restrict contact with vulnerable* persons until 14 days after symptom onset.

    *Individuals vulnerable to severe illness related to COVID-19 include those who are age 65 and above, or with underlying medical conditions such as chronic lung disease or moderate to severe asthma, chronic heart disease, diabetes, end stage kidney or liver disease or weakened immune systems such as cancer patients, those on immunosuppressive therapy and HIV/AIDS.

Clients, Vendors, and Visitors: Contact any clients, vendors, and visitors who may have been exposed to a presumed or confirmed case, especially those who are at higher risk for severe infection. Instruct them to self-quarantine and monitor symptoms for 10 days after last exposure, even if they receive a negative test result during their quarantine period. If they remain asymptomatic, they are released from quarantine after Day 10 but must continue to monitor their health and strictly adhere to COVID-19 prevention precautions through Day 14 (see above Quarantine Instructions for Contacts). Clients, vendors, and visitors should call their primary care provider to discuss testing options.

CONTROL RECOMMENDATIONS FOR OUTBREAKS IN IHE CONGREGATE NON-RESIDENTIAL SETTINGS

  1. Reinforce good hand hygiene among all (including clients, vendors, and visitors).
  2. Emphasize respiratory etiquette (cover cough and sneezes, dispose of tissues properly).
  3. Sick persons (including clients, vendors, and visitors) with symptoms of COVID-19, even with mild symptoms, should be restricted from entering the campus and urged to stay home and self-isolate.
  4. Consider screening all persons on campus, including clients, vendors, and visitors, for fever by measuring body temperature.
  5. Urge employees and students to quarantine at home if someone in their house is sick.
  6. Emphasize importance of early detection of cases and removing them from contact with others.
  7. Ensure adequate and easily accessible supplies for good hygiene, including:
    • Tissues and trash receptacles
    • No touch hand sanitizer dispenser near customer entrances if feasible.
    • Handwashing stations
    • Soap
    • Paper towels
    • Alcohol‐based hand sanitizer.
  8. Minimize, where possible, close contact and the sharing of objects.
  9. Close off areas used by cases and do not use these areas until after cleaning and disinfecting. Open outside doors and windows to increase air circulation in the areas and then begin cleaning and disinfecting. If more than 24 hours have passed since a COVID-19 case was on site, only cleaning is required (not disinfecting). Cleaning should include cleaning of frequently touched surfaces and objects. If disinfecting, use an EPA-registered disinfectant approved for emerging viral pathogens (see www.epa.gov/pesticide-registration/list-n-disinfectants-use-against-sars-cov-2).
  10. IHE administrators should work with Public Health to determine if closure is needed to prevent the spread of COVID-19.
  11. Notify all employees and students (at IHE sites) of COVID-19 outbreak at the site while maintaining patient privacy, and reinforce prevention measures across the facility/site.
  12. Provide employees, staff, clients, vendors, and visitors, if possible, with accurate and updated Public Health information and materials about novel coronavirus. Signage should be posted at the worksite to reinforce frequent hand washing, cover your cough and maintain social distancing.
  13. Consider discontinuing in-person group events and meet virtually instead; otherwise practice social distancing per required distance of space between people if an in-person event is essential. (See Table 1: Physical Distancing Measures for Institutes of Higher Education Non-Residential Congregate Settings).
  14. Increase routine cleaning and disinfection of all frequently touched surfaces and objects.
  15. Implement strategies to protect employees who are at higher risk for adverse health complications. This may include strategies such as telecommuting, staggering shifts, and cross training staff.
  16. Instruct the facility to maintain daily visitor log, if feasible, with date and time of visit.
  17. Refer to ( Table 1: Physical Distancing Measures for Institutes of Higher Education Non-Residential Congregate Settings.

CONTROL RECOMMENDATIONS FOR OUTBREAKS IN IHE CONGREGATE RESIDENTIAL SETTINGS

  1. Designate an area for the placement of presumed and confirmed residents. Refer to Guidelines for Proper Grouping of Residents. Note: The actual isolation area will depend on each building but define the area by your local workflow (e.g. the unit the resident is located would be a logical decision).
    1. Case(s) should be isolated in single-person room(s). Move roommates into other rooms within the isolation area, if possible. Otherwise, cohort case(s) together in a separate room with the door closed and a dedicated restroom.
    2. Cohort staff (keep the same, limited number of staff caring for the COVID-19 residents and ensure they do not interact with other non-quarantined residents).
    3. Move presumed COVID-19 residents into the isolation area if suspicion for COVID-19 is high.
  2. Designate a quarantine area for residents who have been identified as contacts to case(s).
    1. Residents should use masks or face coverings. If possible, initiate full contact, droplet, and eye protection precautions in the quarantine area.
    2. Place asymptomatic residents identified as close contacts in the quarantine area.
    3. Post signage of your quarantine area.
    4. Cohort staff as much as possible to minimize transmission.
  3. Quarantined residents should
    1. Not be allowed visitors and should have limited contact with staff and other residents.
    2. Stay in a separate room as much as possible and away from residents who are vulnerable to severe illness related to COVID-19. Individuals vulnerable to severe illness related to COVID-19 include those who are age 65 and above, or with underlying medical conditions such as chronic lung disease or moderate to severe asthma, chronic heart disease, diabetes, end stage kidney or liver disease or weakened immune systems such as cancer patients, those on immunosuppressive therapy and HIV/AIDS.
    3. Use a separate bathroom.
  4. Asymptomatic residents must monitor for symptoms while in quarantine. If they remain asymptomatic, they may be released from quarantine after 10 days from the last day the resident was in contact with a case but must continue to monitor their health and strictly adhere to COVID-19 prevention precautions through Day 14 (see above Quarantine Instructions for Contacts).
  5. If quarantined residents develop symptoms of COVID-19 , then they should be moved to isolation area and COVID-19 testing should be recommended.
  6. If during the quarantine period, there is contact with a person with confirmed COVID-19 (being within 6 feet for a total of 15 minutes or more within a 24-hour period or touching body fluids or secretions without using the appropriate precautions) the quarantine period will have to restart. Body fluids or secretions include sweat, saliva, sputum, nasal mucus, vomit, urine, or diarrhea.
  7. Continue to monitor all residents for fever and symptoms of COVID-19 from last date of exposure at facility to end of the quarantine period. Last COVID-19 exposure at facility is until the last COVID-19 case (staff or resident) is placed under isolation. Any breach in isolation of COVID-19 case would constitute an ongoing exposure at facility and monitoring period will need to be restart.
  8. Refer to Table 2 for Physical Distancing Measures for Institutes of Higher Education Residential Congregate Settings.

REPORTING

  1. All cases associated with the outbreak facility, occurring with a symptom onset or positive test after the first outbreak-associated case, regardless of whether they are epi-linked, should be reported on the outbreak line list until the end of the surveillance period. The surveillance period ends 14 days from the latest date any outbreak-associated case was on-site or at a facility-related event while infectious.
  2. An outbreak-associated case is a person at the outbreak facility or at a facility-related event who is either (1) the index case in the outbreak or (2) a person with confirmed COVID-19 who is epi-linked to another outbreak-associated COVID-19 case during the surveillance period. A non-outbreak-associated case is a person associated with the outbreak facility with confirmed COVID-19 that has been determined by Public Health to not be epi-linked to an outbreak-associated case.
  3. The Public Health Outbreak Investigator will forward outbreak line lists to ACDC-Education@ph.lacounty.gov when new cases are added.
  4. The Public Health Outbreak Investigator must be notified of a hospitalization and/or death associated with the outbreak facility during the surveillance period.

TESTING CONSIDERATIONS

  1. Public Health recommends diagnostic testing to identify person actively infected with COVID-19 based on symptoms or exposure to prevent spread of COVID-19. This strategy is aimed to supplement infection control, universal source control, and physical distancing measures. With diagnostic testing, when there is a known COVID-19 case, all presumed cases and contacts of confirmed cases are tested whether they have symptoms or not.
  2. The IHE should instruct symptomatic persons and persons with an exposure to get tested as soon as possible. Refer contacts to campus health office, primary care provider, or 2-1-1 for county or city testing sites (2-1-1 for county or city testing sites (https://covid19.lacounty.gov/testing/).
  3. Employers may request that staff/employees report tier test results (see Department of Fair Employment and Housing–Employment Information on COVID-19 and What You Should Know About COVID-19 and the ADA, the Rehabilitation Act, and Other EEO Laws). Employers must maintain confidentiality in compliance with privacy laws.
  4. Asymptomatic contacts who are fully vaccinated or have previously tested positive for SARS-CoV-2 within the past 90 days, do not need to test if identified as a close contact.
  5. Retesting of contacts is not recommended if they remain asymptomatic from date of exposure to end of quarantine period. Retesting is recommended if any of the contacts become symptomatic.
  6. Expanded testing at the site beyond diagnostic testing of close contacts may be considered on a case-by-case basis (e.g. if outbreak is extensive or close contacts are not identifiable due to nature of exposures).

OUTBREAK CLOSURE CRITERIA

  1. The last day of surveillance is the 14th day after the last date that any outbreak-associated case was on site or at a facility-related event while infectious.
  2. Outbreak can be closed if all conditions below are met:
    1. No outbreak-associated cases have occurred within the 14-day surveillance period; and
    2. The facility has implemented all necessary COVID-19 control and preventive measures and observed violations have been abated.
  3. Public Health Outbreak Investigator uploads all documents into IRIS and documents in IRIS per protocol.
  4. Public Health Outbreak Investigator or Supervisor can close COVID-19 outbreak in IRIS after approval by AMD or AMD delegated physician. Closure letter will be signed by AMD or AMD delegated physician.
  5. Public Health Outbreak Investigator sends a courtesy notification to the ACDC investigator and/or ACDC-education@ph.lacounty.gov to inform them that the outbreak is closed and shares the final line list.

Table 1: Physical Distancing Measures for Institutes of Higher Education Non-Residential Congregate Settings

Shared spaces

  • Close common spaces where feasible; otherwise create a schedule for using common space and stagger schedules to ensure that people have at least 6 feet between each other.
  • Re-configure workspaces to create at least 6 feet of space between persons.
  • Add physical barriers in shared settings where it is difficult for individuals to adhere to physical distancing requirements.
  • Provide physical guides, such as tape on floors or sidewalks and signs on walls to ensure that individuals remain in lines per physical distancing requirements.
  • Provide grab and go options for meals; if possible, serve individual plated meals (versus buffet or any self-serve station).
  • Pursue virtual group events, gatherings, or meetings; otherwise practice social distancing per required distance of space between people if events are held.
  • Limit nonessential visitors, volunteers and activities involving external groups or organizations.
  • Use flexible work and learning sites (telework, virtual learning) and flexible work or learning hours (staggered shifts or classes).
  • Recommend and reinforce use of masks among students, faculty, and staff. This is most essential in times when physical distancing is difficult.

Communication

  • Utilize technology to minimize face-to-face meetings.
  • Reinforce messages about behaviors that prevent spread of COVID-19, including physical distancing, when communicating with faculty, staff, and students.
  • Use effective methods for communication, including posting signs in high visible locations, email, website, and social media platforms. 

Staff

  • Encourage telework for as many faculty and staff as possible, especially those most vulnerable to severe illness from COVID-19.
  • Replace in-person meetings with video or tele-conference calls where possible.
  • Re-configure workspaces to create required distance of space between persons.
  • Reduce unnecessary assembly of staff (e.g., large meetings where information can be communicated otherwise).

Students

  • Limit the number of the students in a single classroom to no more than permitted per reopening protocols.
  • Re-engineer classrooms to create required physical distance between student stations, tables, desks and chairs.
  • Eliminate student events that require congregation; otherwise ensure required physical distancing of space between people if events are held.
  • Ensure adequate supplies to minimize sharing of high-touch materials to the extent possible (e.g., assigning each student their own art supplies, lab equipment, computers) or limit use of supplies and equipment by one group of students at a time and clean and disinfect between use.

Table 2: Physical Distancing Measures for Institutes of Higher Education Residential Congregate Settings

Sleeping Arrangements

  • Consider single occupancy rooms where feasible.
  • Move residents with laboratory-confirmed infection into designated isolation housing.
  • Move symptomatic residents into a designated area, preferable with closed doors, and provide separate bathroom if applicable.
  • Move contacts of persons with laboratory-confirmed infection into designated quarantine area.
  • Increase spacing so beds have at least the required physical distancing of space between them.
  • Arrange beds so that individuals lay head to toe, or use neutral barriers (curtains) to create barriers in between the beds.
  • For additional guidance see Bed Positioning Infographic.

Mealtimes

  • Stagger mealtimes to reduce crowding in shared eating facilities.
  • Stagger the schedule for use of common/shared kitchens.
  • Serve meals “to go” if possible.
  • Serve meals in resident rooms, if possible.
  • Stagger dining times to decrease the size of the groups.

Bathrooms/Bathing

  • Create a staggered bathroom/bathing schedule to reduce the amount of people using the facilities at the same time.

Recreation/Common areas

  • Close common space, where feasible; otherwise create a schedule for using common space and stagger schedules to ensure that people have at least the required physical distancing of space between each other.
  • Reduce activities that congregate any resident at once.
  • If smaller group activities are necessary, keep the same group together to decrease the risk for virus spread.
  • If symptomatic residents need to move through areas with asymptomatic residents, they should wear a mask, and minimize the time in these areas.

Communication

  • Reduce the amount of face-to-face interactions with residents for simple informational purposes.
  • Consider using alternative methods of communication: Bulletin boards, signs, posters, phone, sliding information under doorway.

Staff Activities

  • Reduce unnecessary assembly of staff (e.g., large meetings where information can be communicated otherwise).


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