Notes from ME DHHS Medical Directors Call 10/04/2022

Maine Epidemiology Updates:
  • Over the past several weeks we have started to see some early signs of a fall surge. Case numbers are going up slightly and the number of hospitalizations are definitely up. As usual, case numbers don't reflect the entirety of what's going on out there. We do not have specific capacity concerns that the CDC has heard about from hospitals but everything is trending up.
  • Bivalent boosters have moved out across the state. We currently have a much better supply of Pfizer than Moderna but the Moderna supply is starting to come in as well.
Update on LTCOP Vaccine Initiative:
  • The LTC Ombudsman has been working with both ETHOS marketing and design, the Maine CDC, DHHS Division of Licensing and Certification and OADS to plan a campaign to regarding vaccination outreach campaign to increase vaccination rates among direct care staff in nursing homes, assisted housing and home care. The goal is to increase vaccination, develop outreach materials to communicate the benefits of vaccination for COVID-19 and influenza, to normalize COVID-19 vaccination as a standard immunization, and finally increase information and awareness with social media. This campaign will have a landing page that is ready to be launched in the next day or two and LTCOP will send the link soon. There was a real emphasis on peer-to-peer support as noted in the surveys of direct care workers that influenced this work. This initiative is going to launch an ambassador program in addition to the resources, so direct care staff identified in facilities could receive a stipend, and with support encourage their colleagues to be vaccinated. We will be working with the facility administrators and perhaps the medical directors and whoever else in facility. as I said they would get it stipend and we can guide and some information and it's a new venture so we think it can be very successful with the collaborative effort last staff and facility staff so and again the landing page be out there
Updates on CDC Guidance Recommendations:
  • Throughout the guidance there has been a change away from the words “recommendations” to ‘facilities should consider or choose.” Those are purposeful changes that CDC has made in order to move away and in some areas moved from issuing specific health care worker recommendations like they have in the past. That doesn't mean that facilities can't implement some of the same strategies that they have been using and they are encouraged to implement further actions based on what's on going at your facility and what might be the prevalence in your county.
  • CDC is continuing to recommend for healthcare facilities to use the community transmission level for a metric for stratifying some other measures in regards to source control, universal PPE, etc. so that is not a change, that is a continuation with one slight note - if there is a time when the community level which is the guidance that is used for the general public was high and the community transmission level was low the community level would trump the community transmission level and so that would mean source control is indicated for ALL when indoors.
  • Source control for healthcare workers is indicated when your community transmission level is HIGH. This used to be laid out as low, moderate, substantial, high but now the guidance refers to high or not high. When your community transmission level is HIGH source control is recommended in all areas of the health care facilities where patients and residents can be encountered.  A facility could choose to allow healthcare workers not to wear source control when in well-defined areas that they are not going to have contact with patients or residents.  
  • If facilities are in low to substantial community transmission, facilities could choose to not require universal source control; however, there are some bullet points where it still would be recommended. When removing the requirement for source control, homes should wait for a two week period at low to substantial levels that way you are not going back and forth with source control requirements.
  • There are now differences in terminology between source control and PPE. When CDC says source control, they mean wearing a well fitted mask. When they say PPE CDC mean that you should be using i personal protective equipment for the care of or when in contact with an individual who is on some type of transmission-based precautions. As you go through the guidance note those slight changes.
  • Eye protection: this is a slight change where CDC guidance used to say eye protection should be worn during all high-risk patient care and resident encounters. This is now a consideration.
  • Screening:  Per US CDC there's no longer any language that talks about active screening; however, facilities are encouraged if this is something that is helpful based on what's going on in your facility, for instance an outbreak etc. or at any point in time you could choose to continue to implement screening.
  • Screening of staff, visitors etc. is no longer a requirement for facilities. It is now a recommendation; however, homes should have a process established to make sure that everyone entering the facility including visitors is aware of recommended actions to take to prevent transmission or if they had any of the following three criteria of COVID:
    1. Positive viral test
    2. Symptoms or
    3. Close contact with someone with suspected or confirmed infection
  • CDC is encouraging the use of signage to communicate this information in your lobbies and doorways.
  • The US CDC no longer states that a facility has to have a unit in waiting for confirmed COVID residents; however, guidance does state that you should have the ability to put one in place should you need it.
Maine DHHS Licensing Updates:
  • According to licensing, this means you're not required to have a dedicated reserve area, but you are required to have a plan. So what surveyor are going to be looking at is what is your facilities' plan whether it's part of your emergency plan, or your infection control plan for establishing a dedicated area to cohort or isolate individuals should an outbreak occur.
  • Testing: you are no longer required to test all staff who are not up to date on vaccinations but you would still have to have a process for those who are not vaccinated  such as exempted staff.
  • During a recertification survey of nursing homes, licensing would do an audit of compliance with the federal healthcare worker vaccination rule. So facilities will still be audited during the recertification survey for vaccination status and any unvaccinated worker would require the home to show licensing your plan and your process consistent with 42 CFR regulation that requires facilities ensure staff who are not yet fully vaccinated or left pending. Go to appendix Aa of QSO 22-07 which has this language and suggestions for reassigning staff that have not completed their primary vaccination series.
  • As a refresher, you are no longer required to have an active person standing outside or an active screening process for staff before someone enters your home; however, there is still an expectation that you have a process to ensure that somebody is evaluating staff. That could be the charge nurse or supervisor at the beginning of a shift. These new revised regulations are putting more of the responsibility on the facility to modify its infection control plan and base it off national standards. That is what licensing is going to ask you to show if there's a question regarding this.