COVID-19 Testing Leaders Guide

COVID-19 Testing

 

Leader’s Guide

 

Testing for SARS-CoV-2 (COVID-19) is essential to identify positive cases as soon as possible to implement mitigation efforts to prevent the spread of infection in the facility. Testing is also required for regulatory compliance.

 

There are multiple factors to consider when addressing COVID-19 testing and the role in the prevention of the spread of COVID-19 in the Long-Term Care Setting.

 

Policies and procedures following the guidelines provided through CMS, CDC, and State specific guidance will enable the facility to consistently implement strategies to maintain the health, safety, and welfare of residents and staff.

 

A solid testing plan, consistent with CMS and State guidance, identifying equipment and supply needs and acquisition, staff education and verification of competency for COVID-19 testing, reporting and documentation is essential for quality to prevent the spread of infection and compliance.   Through an established policy and procedure, testing of residents and staff in accordance with guidance, will be an essential component to the COVID-19 Pandemic Plan and reopening process.

 

Some areas to be considered for COVID-19 Testing may include:

 

• Staff Resources:
• Infection Preventionist
• Licensed Nurses
• All Staff
• Administrator
• Director of Nursing Services and designee

 

• Education:
• Infection Control Practices and Prevention of Transmission
• Policies and Procedures for Infection Control, including COVID-19
• COVID-19 testing policies and procedures
• Proper use and application of Personal Protective Equipment
• Hand hygiene procedures
• Specimen Collection
• Use of Point-of-Care COVID-19 Antigen Testing Device
• Cleaning and Disinfection
• Reporting
• Prompt Action for positive results

 

 

 

• Documentation Considerations:
• CLIA Certificate of Waiver
• Employee education and competency demonstration outcomes
• COVID-19 Testing Plan
• Risk Assessment
• COVID-19 Test Results
• Resident Refusals
• COVID-19 Test Results Reporting

 

• Reporting
  • NHSN Reporting- COVID-19 Module for LTCF
  • CLIA requirement to report the results of all Point of Care (POC) antigen tests performed in the facility to CDC through NHSN reporting. https://www.hhs.gov/sites/default/files/covid-19-laboratory-data-reporting-guidance.pdf
  • CMS How to obtain a CLIA Certificate: https://www.cms.gov/regulations-and-guidance/legislation/clia/downloads/howobtaincliacertificate.pdf
  • Centers for Disease Control and Prevention. How to Report COVID-19 Laboratory Data. Updated Dec. 28, 2020: https://www.cdc.gov/coronavirus/2019-ncov/lab/reporting-lab-data.html
    
    
• Monitoring and Evaluation
• Observation of staff performance with coaching as needed
• Staff interview regarding availability and use of PPE and face masks
• Observation of specimen collection
• Observation of testing performance
• Medical Record Audit for documentation of test results
• COVID-19 tracking and trending
• QAPI review and reporting

 

References and Resources:

 

Centers for Medicare & Medicaid Services. 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. QSO-20-38-NH. August 26, 2020: https://www.cms.gov/files/document/qso-20-38-nh.pdf

 

Centers for Medicare & Medicaid Services. Interim Final Rule (IFC), CMS-3401-IFC, Updating Requirements for Reporting of SARS-CoV-2 Test Results by Clinical Laboratory Improvement Amendments of 1988 (CLIA) Laboratories, and Additional Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency. QSO-20-37-CLIA, NH. August 26, 2020: https://www.cms.gov/files/document/qso-20-37-clianh.pdf

 

Centers for Medicare & Medicaid Services. Nursing Home Reopening Guidelines for State and Local Officials; May 18, 2020. Revised 09/28/20; QSO 20-30-NH; https://www.cms.gov/files/document/qso-20-30-nh.pdf

 

Centers for Disease Control and Prevention. Preparing for COVID-19 in Nursing Homes; November 20, 2020; https://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. December 28, 2020: https://www.cdc.gov/coronavirus/2019-ncov/hcp/nursing-homes-antigen-testing.html

 

Centers for Disease Control and Prevention: Testing Guidelines for Nursing Homes. Updated Oct. 16, 2020: https://www.cdc.gov/coronavirus/2019-ncov/hcp/nursing-homes-testing.html

 

Centers for Disease Control and Prevention. Guidance for SARS-CoV-2 Point-of-Care Testing. Updated December 26, 2020: https://www.cdc.gov/coronavirus/2019-ncov/lab/point-of-care-testing.html

 

Centers for Disease Control and Prevention. How to Report COVID-19 Laboratory Data. Updated Dec. 28, 2020: https://www.cdc.gov/coronavirus/2019-ncov/lab/reporting-lab-data.html

 

Centers for Disease Control and Prevention. National Healthcare Safety Network (NHSN) LTCF COVID-19 Module: https://www.cdc.gov/nhsn/ltc/covid19/index.html

 

Centers for Disease Control and Prevention. COVID-19 Testing Resources for Nursing Homes: https://www.cdc.gov/coronavirus/2019-ncov/downloads/hcp/COVID-19-Testing-Resources-for-Nursing-Homes.pdf

 

Centers for Medicare & Medicaid Services. Clinical Laboratory Improvement Amendments (CLIA): https://www.cms.gov/Regulations-and-Guidance/Legislation/CLIA

United States Health & Human Services. COVID-19 Pandemic Response, Laboratory Data Reporting: Cares Act Section 18115: https://www.hhs.gov/sites/default/files/covid-19-laboratory-data-reporting-guidance.pdf