--- title: COVID-19 Outbreak Management Checklist description: The below is a checklist of steps recommended to be completed by the organization related to a COVID-19 Outbreak Management. 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This checklist was designed to provide a preparation and management for a COVID-19 outbreak. This resource can provide leadership, clinical and staff actions in accordance with organization policy and procedures, federal requirements and state/local public health department.   | **Action Steps** | **Completed** | **Follow Up Actions** | | | --- | --- | --- | --- | | **Yes** | **No** | | | | ** ** **COVID-19 Outbreak Preparation and Management Plan should include the following:     ** | | | | | 1. Infection Preventionist designation and authority | ** ** | ** ** | ** ** | | 1. Identify and designate space in the facility that will be dedicated to care for residents with confirmed COVID-19 | ** ** | ** ** | ** ** | | 1. Determine dedicated and essential staffing plan | ** ** | ** ** | ** ** | | 1. Prepare a “COVID-19 Outbreak Investigation and Management Policy and Procedure” | ** ** | ** ** | ** ** | | 1. Prepare a plan for screening | ** ** | ** ** | ** ** | | 1. Prepare an interdisciplinary leadership plan for resident placement                                                i.     Isolation                                               ii.     Quarantine                                              iii.     Co-horting                                              iv.     PPE                                               v.     Signage | ** ** | ** ** | ** ** | | 1. Implement the process for isolation/quarantine in single/private room and process for observation and monitoring of new admissions and readmissions for evidence of COVID-19                                                i.     Gloves                                               ii.     Gown                                              iii.     Eye Protection                                              iv.     N95 or higher equivalent (mask if no N95 available) | ** ** | ** ** | ** ** | | 1. Implement the process for placement in private room to quarantine on isolation and care of residents exposed to COVID-19                                                i.     Gloves                                               ii.     Gown                                              iii.     Eye Protection                                              iv.     N95 or higher equivalent (mask if no N95 available) | ** ** | ** ** | ** ** | | 1. Implement a separate space in the facility that can be dedicated for the care of residents who are confirmed to be positive for COVID-19. | ** ** | ** ** | ** ** | | 1. Prepare an emergency staffing plan in the event of a COVID-19 outbreak | ** ** | ** ** | ** ** | | 1. Prepare a plan for employees exposed to COVID-19 | ** ** | ** ** | ** ** | | 1. Prepare a plan for employee with COVID-19 | ** ** | ** ** | ** ** | | 1. Universal source control | ** ** | ** ** | ** ** | | 1. Identify Personal Protective Equipment Supply | ** ** | ** ** | ** ** | | 1. All Staff Education | ** ** | ** ** | ** ** | | 1. Prepare Testing Procedures consistent with State, CMS and CDC guidance:         [https://www.cms.gov/files/document/qso-20-38-nh.pdf](https://www.cms.gov/files/document/qso-20-38-nh.pdf) | ** ** | ** ** | ** ** | | 1. Create a list of emergency contacts:   | ** ** | ** ** | ** ** | | **COVID-19 Outbreak Plan** | | | | | 1. Resident Confirmed COVID-19: Immediate isolation in private room (or cohort residents with COVID-19 confirmation) with door closed on COVID-19 unit/dedicated space. §  Implement transmission-based precautions (COVID-19) §  Full PPE §  Gloves §  Gown §  Eye Protection §  N95 or higher respirator | ** ** | ** ** | ** ** | | 1. Implement dedicated, essential staff on COVID-19 unit | ** ** | ** ** | ** ** | | 1. Health Department notification | ** ** | ** ** | ** ** | | 1. Implement COVID-19 Outbreak testing for employees and residents consistent with CMS guidance:   [https://www.cms.gov/files/document/qso-20-38-nh.pdf](https://www.cms.gov/files/document/qso-20-38-nh.pdf) | ** ** | ** ** | ** ** | | 1. Complete clinical assessment of resident §  Document in medical record | ** ** | ** ** | ** ** | | 1. Complete Notifications (Physician, resident, representative) and document in the medical record | ** ** | ** ** | ** ** | | 1. Document on 24 Hour Report   | ** ** | ** ** | ** ** | | 1. Add to resident line list   | ** ** | ** ** | ** ** | | **Communication Plan – Confirmed COVID-19 ** | ** ** | ** ** | ** ** | | 1. Resident representative will be informed of COVID-19 Status | ** ** | ** ** | ** ** | | 1. Local/Health Public Health Department | ** ** | ** ** | ** ** | | 1. The facility will inform all residents and their families and/or representatives of COVID-19 outbreak status in facility | ** ** | ** ** | ** ** | | 1. Employee Communication | ** ** | ** ** | ** ** | | 1. Medical Director will be promptly informed | ** ** | ** ** | ** ** | | 1. CLIA Reporting – COVID-19 testing in facility | ** ** | ** ** | ** ** | | 1. NHSN Reporting | ** ** | ** ** | ** ** | | 1. Other:   | ** ** | ** ** | ** ** | | **Disinfection Criteria ** | | | | | Equipment 1. Dedicated or disposable patient-care equipment should be used [https://www.epa.gov/pesticide-registration/list-n-disinfectants-coronavirus-covid-19](https://www.epa.gov/pesticide-registration/list-n-disinfectants-coronavirus-covid-19)   | ** ** | ** ** | ** ** | | 1. Cleaning and disinfecting room, high touch areas and equipment will be performed using products that have EPA-approving emerging viral pathogens: [https://www.epa.gov/pesticide-registration/list-n-disinfectants-coronavirus-covid-19](https://www.epa.gov/pesticide-registration/list-n-disinfectants-coronavirus-covid-19)     | ** ** | ** ** | ** ** | | **Staff Re-Education (reinforce infection control protocols)** | | | | | The facility will re-educate employees and reinforce: §  COVID-19 Signs and Symptoms §  Screening process §  Hand Hygiene practices §  Cough Etiquette and Respiratory Hygiene §  Resident Placement and Transmission Based Precautions §  Appropriate Utilization of PPE §  PPE Sequencing specific for COVID-19 §  Optimization protocols for PPE §  Isolation §  Consistent staff assignment §  Staff roles and responsibilities   | ** ** | ** ** | ** ** | * * ***NOTE: The situation regarding COVID-19 is still evolving worldwide and can change rapidly. Stakeholders should be prepared for guidance from CMS and other agencies (e.g., CDC) to change. Please monitor the relevant sources regularly for updates.*** ** ** ** ** **References and Resources**   Centers for Medicare & Medicaid Services: QSO-20-38-NH, Interim Final Rule (IFC), CMS-3401-IFC, Additional Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency related to Long-Term Care (LTC) Facility Testing Requirements and Revised COVID19 Focused Survey Tool. August 26, 2020: [https://www.cms.gov/files/document/qso-20-38-nh.pdf](https://www.cms.gov/files/document/qso-20-38-nh.pdf)   Centers for Disease Control and Prevention. Clinical Questions about COVID-19: Questions and Answers. Updated Dec. 28, 2020: [https://www.cdc.gov/coronavirus/2019-ncov/hcp/faq.html#Testing-in-Nursing-Homes](https://www.cdc.gov/coronavirus/2019-ncov/hcp/faq.html#Testing-in-Nursing-Homes)   Centers for Disease Control and Prevention. Optimizing Personal Protective Equipment (PPE) Supplies. Updated July 16, 2020: [https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/index.html](https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/index.html)   Centers for Disease Control and Prevention. Preparing for COVID-19 in Nursing Homes. Updated Nov. 20, 2020: [https://www.cdc.gov/coronavirus/2019-ncov/hcp/long-term-care.html](https://www.cdc.gov/coronavirus/2019-ncov/hcp/long-term-care.html)   Centers for Disease Control and Prevention. Considerations for Use of SARS-CoV-2 Antigen Testing in Nursing Homes. Updated Dec. 28, 2020: [https://www.cdc.gov/coronavirus/2019-ncov/hcp/nursing-homes-antigen-testing.html](https://www.cdc.gov/coronavirus/2019-ncov/hcp/nursing-homes-antigen-testing.html) ** ** **FDA Resources: ** Emergency Use Authorizations: https://www.fda.gov/medical-devices/emergency-situations-medical-devices/emergency-use-authorizations ** ** **CMS Additional Resources** Long term care facility – Infection control self-assessment worksheet: https://qsep.cms.gov/data/252/A._NursingHome_InfectionControl_Worksheet11-8-19508.pdf   Infection control toolkit for bedside licensed nurses and nurse aides (“Head to Toe Infection Prevention (H2T) Toolkit”): https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/LTC-CMP-Reinvestment   Infection Control and Prevention regulations and guidance: 42 CFR 483.80, Appendix PP of the State Operations Manual. See F-tag 880: https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/GuidanceforLawsAndRegulations/Downloads/Appendix-PP-State-Operations-Manual.pdf