A. Two or more unknown respiratory cases within 72 hours
- Define a quarantine area around the suspect patient(s).
Note: The actual quarantine area will depend on each building but define the area by your local workflow (e.g., the unit the patient is located
would be a logical decision).
- If it is possible to move roommates into other rooms within the quarantine area, then move them. Otherwise, keep them in place.
- Consider moving suspect patients into the quarantine area if suspicion for COVID-19 is high.
- Cohort staff (keep the same, limited number of staff caring for the COVID-19 patients and ensure they do not interact with other non-quarantined patients).
- For any transfers out of the building, notify EMS and the receiving facility regarding possible COVID-19 exposure to minimize transmission.
- Initiate standard, contact, and droplet precautions plus eye protection for all suspect patients with fever and/or respiratory symptoms.
- Encourage testing for routine respiratory pathogens if available at the facility.
- Test for Influenza and/or other respiratory pathogens to establish an alternative diagnosis.
- If COVID-19 testing is available, consider sending tests to commercial laboratories.
- Increase environmental cleaning throughout the facility with emphasis on high touch surfaces, particularly in the unit where the patient was located
If you have not already done so, ensure that you are using and EPA approved cleaning agent
List N: Disinfectants for Use
- Restrict all visitation except for certain compassionate care situations, such as end of life.
- Restrict all volunteers and non- essential healthcare personnel (e.g., barbers).
- Identify all HCP that have been in contact with that patient 48 hours prior to symptom onset.
- Discontinue all community and group events and outings.
- Serve meals in patient rooms if possible, or stagger dining times to decrease the size of the groups.
- If smaller group activities are necessary, keep the same group together to decrease the risk for virus spread.
- Limit the number of staff members interacting with the symptomatic patient and try to keep the same individuals caring for the patient as much as possible.
- Monitor all HCP (regardless of contact with a case) for fever, cough, and shortness of breath.
Symptomatic healthcare workers may not work. Recommend
checking all HCPs for fever (>100.0° F) and respiratory symptoms at the beginning of the shift.
- Notify DPH immediately if any HCP contact tests positive for COVID-19.
- For symptomatic HCPs, ensure they are not working. They should follow
CDC return to work guidance.
- Cancel and re-schedule all upcoming non-essential medical appointments
B. Two or more confirmed COVID-19 cases
- The confirmed cases should be in a single- person room or cohorted in a single room with the door closed and a dedicated restroom.
of symptomatic patients should be done through a commercial lab, if possible.
- Mass testing is recommended for staff and patients,
- If mass testing strategy for early intervention is to be instituted, see
Mass Testing Strategies for Long-Term Care Facilities
(LTCF) and Other Congregate Settings guidance.
- Post a notification letter at the entrance of the facility and community area.
- Notify all families and patients of COVID-19 cases. Identify and notify all HCP that have been in contact with that patient 48 hours before the onset date
- Instruct the facility to do active monitoring of their patients and staff: monitor for fever and signs/symptoms of cough, sore throat, and shortness of
breath twice a day.
- Identify facility staff who can monitor sick staff with daily “check-ins” using telephone calls, emails, and/or texts.
- Instruct facility to notify LAC DPH immediately if any report fever or respiratory symptoms.
- Implement a line listing of all HCW, patients, and visitors with symptoms.
- Instruct HCP to notify all other employers of the type and nature of their exposure.
- Identify and notify all visitors that have been in contact with the confirmed patient to self- isolate and monitor for fever (>100.0° F) or signs/symptoms
of cough, sore throat, and shortness of breath twice a day for 14 days.
- HCP assigned to a case should wear full PPE. But if PPE shortage, a mask (surgical mask or higher) and eye protection should be worn for all patient
encounters. For conservation of PPE, please refer to CDC
Note: The rationale for mask
and eye protection is to try to prevent HCP exposure. Surgical masks can be worn for an extended period but should be discarded after they become saturated with
- Inform the facility to perform infection control audits and increase environmental cleaning throughout the with emphasis on high touch surfaces particularly
in the unit where the patient was located.
- Place symptomatic patients on isolation in a private room with droplet/contact precautions or within the COVID-19 designated area if available.
- Place asymptomatic patients in the quarantine area.
- Post signage of your quarantine area.
- Initiate Contact, Droplet, and eye protection precautions in the quarantine area.
- Confirmed COVID-19 patients may be cohorted together in the same room, otherwise they should be in a single room if possible.
- Cohort staff as much as possible to minimize transmission.
- The facility to consult with the DPHN assigned to the facility regarding closure of the facility to new/returning admissions.: Refer to
Interfacility Transfer Rules During COVID-19
Discontinuation of Transmission-Based Precautions and Disposition of Patients with COVID-19 in Healthcare Settings: For more details, refer
CDC Discontinuation of Transmission-Based
Precautions and Disposition of Patients with COVID-19 in Healthcare Settings.
- If discontinuing isolation for suspect cases, facilities are advised to do the following:
- Patients should be tested 2 times at least 24 hours apart given the high false-negative rate of testing. Once the negative test results are received,
discontinue isolation unless an alternative diagnosis requires transmission-based precautions.
- If testing is not available or not tested:
- At least 10 days after symptom onset AND at least 1 day (24 hours) afebrile (< 100.0° F) without the use of antipyretic medications AND improvement of
- If discontinuing isolation for confirmed symptomatic patients with COVID-19, facilities are advised to do the following:
- Symptomatic-based strategy
- At least 1 day (24 hours) have passed since recovery defined as resolution of fever without the use of antipyretic medications and
improvement in symptoms; and,
- At least 10 days have passed since symptoms first appeared
- Test-based strategy
- Resolution of fever without the use of fever-reducing medications and
- Improvement in respiratory symptoms (e.g., cough, shortness of breath), and
- Negative results of at least two consecutive respiratory specimens (e.g., nasopharyngeal swab) collected ≥24 hours apart (total of two negative specimens).
- If discontinuing isolation for asymptomatic laboratory-confirmed patients with COVID-19, facilities are advised to do the following:
- Time-based strategy:
10 days have passed since the date of their first positive COVID-19 diagnostic test, assuming they have not subsequently developed
symptoms since their positive test. (Note: since symptoms cannot be used to determine where these individuals are in the course of their illness, so there is a
possibility the duration of viral shedding may be shorter or longer than 10 days after their positive test).
- Test-based strategy:
Negative results of at least two consecutive respiratory specimens (e.g., nasopharyngeal swab) collected ≥24 hours apart (total of
two negative specimens).
- Transmission-Based Precautions have been discontinued, but the patient has persistent symptoms from COVID-19 (e.g., persistent cough), they should be placed
in a single room, be restricted to their room, and wear a facemask (if tolerated) during care activities until all symptoms are completely resolved or at
Interfacility transfer from hospital to Acute Psychiatric Hospital and Transmission-Based Precautions:-Refer to
Interfacility Transfer Rules During COVID-19 PANDEMIC
Interfacility transfers should be limited as much as possible, while still maintaining appropriate levels of care for all patients.
Patients should not
be sent to the Emergency Department (ED) to obtain SARS CoV-2 testing.
- For patients not needing hospital admission:
Refer to Return-to-Facility Discharge Rules for Patients in the
- Patients who developed symptoms of COVID-19 in the acute psychiatric hospital and are transferred to acute care hospital may return to the facility of
origin once clinically stable if staffing levels are adequate. They should be placed in COVID-19 dedicated area.
- New COVID-negative admissions to the acute psychiatric hospital should be restricted based on the assessment of the AMD or AMD delegated physician and
depends upon the layout of the facility and the capacity for the facility to separate COVID positive patients from negative patients and whether there is
evidence of ongoing transmission (i.e., new symptomatic cases) in the facility.
Transfers from one acute psychiatric hospital to another acute psychiatric hospital: LAC DPH does not recommend transferring patients to
hospitals unless they require higher level of care or is unable to isolate the patient adequately. Refer to
InterfacilityTransfer Rules During COVID-19
PANDEMIC. If the facility is a dedicated COVID receiving facility, they may accept transfers of COVID+ patients from other acute psychiatric hospital.