Health Protocols for Prevention of COVID-19 in Nursing Homes
Affiliated with Social Care Centers
The Environment and the Safety of the Elderly and Workers
- Must ensure the availability of personal protection equipment.
- Hand sanitizers must be distributed (containing 60-80% alcohol) as per the requirements of the Saudi Food and Drug Authority (SFDA) and must be placed in prominent places as well as attached to the walls.
- Must ensure the availability of hand soap in the bathroom and hand sanitizers near the washbasins and entrances to the bathrooms.
- All places and surfaces should be cleaned with soap and water before disinfecting them.
- The health practitioner must pay close attention to keeping their hands clean by washing them with soap and water for 40 seconds or using an alcohol-based hand sanitizer (containing 60-80% alcohol) for 20 seconds, especially before and after being in contact with the elderly or touching their belongings.
- Must adhere to regular cleaning of environmental surfaces and toilets after every use with disinfectants that are approved by the SFDA or the Ministry of Health (MOH) and follow the instructions for disinfection of health facilities.
- A record of the times of cleaning and disinfection of surfaces and toilets should be maintained, and another record designated for disinfection periods should also be maintained.
- It is preferable to provide sensor automatic taps in the bathrooms, and if not available, a cleaner must be assigned to regularly disinfect the bathroom, especially the taps, washbasins and door handles.
- Must ensure good ventilation in all places, especially gathering places and bathrooms, with the use of natural ventilation.
- Must change or clean air filters for ventilation equipment, especially air conditioners, regularly.
- Single-use items such as disposable spoons and plates should be provided in the social care centers, in addition to personal use items for the elderly such as towels and clothes.
- Disinfection of interactive screens or indicative screens that operate by touch, if any, or placing disinfecting wipes next to it.
- Provide trash cans and waste baskets that are used with no touching required, and the waste must be disposed of continuously.
- The health personnel and practitioners should wear surgical masks for all working hours and follow the instructions to control infection in health facilities.
- Visitors must wear surgical masks for the full duration of their visit.
- The elderly should not be forced to wear masks because of the breathing difficulty it may cause them, and each patient should be evaluated by their doctor to know if they are able wear a mask or not.
- In terms of health, the elderly should be urged to cover their mouth and nose with any fabric cover.
- Handshakes and hugs between the elderly and visitors must be prevented.
- Crowds and gatherings in the elderly’s rooms must be prevented, and the implementation of social distancing (one and a half meters apart) between the elderly in the common rooms must be emphasized.
- Implement social distancing in any necessary group activities and if having their food together.
- Cancel external activities such as trips, outdoor tours and others.
Reporting and Monitoring
Visiting relatives and Friends
- Regulating visits to the Nursing homes. Each nursing home must develop an appropriate plan to regulate the visiting periods, for example:
- Facilitate the use of alternative communication methods, such as the use of telecommunications applications.
- Restrict visits to specific hours and locations within the nursing home for all visitors and schedule them in advance to avoid crowds.
- Do not allow people who are not related to the elderly to enter the nursing home such as volunteers and non-medical service providers (e.g. barbers and advisors).
- Oblige visitors to wear a surgical mask and surgical gown throughout their visit and clean their hands well with an alcohol-based sanitizer before entering.
- Require visitors to inform the officials in the nursing homes if they develop symptoms of respiratory infection within 14 days of visiting the center.
- A checkpoint should be situated at the entrance to the nursing home, which includes measuring the temperature with a device approved by the SFDA and asking if the have any respiratory symptoms (cough or shortness of breath).
- A register for the entrants and visitors to the centers must be created.
- Someone with a high temperature (38C or above) or having symptoms of a respiratory infection must be prevented from entering the center
- The visitor should be alerted to go directly to the guest’s room and then leave the center immediately after their visit has ended.
Health Workers in the Nursing Homes
- Workers, health practitioners and the elderly should be tested every morning and they should disclose any symptoms such as fever, cough or shortness of breath, fill out the disclosure form, and adhere to the protection and safety methods inside and outside the center.
- Prevent any employee who has a high temperature (38C or above) or has any respiratory symptoms from entering the center.
- The elderly’s temperature should be checked on a daily basis and ask them if they feel any respiratory symptoms.
- Any unusual symptoms that affect the elderly, such as fatigue, muscle pain, dizziness, diarrhea, should be noted, as they should be asked periodically if they have any irregular symptoms in addition to the common symptoms of COVID-19.
- Report a case that has a high fever or respiratory symptoms and is suspected of being infected with COVID-19, identify the case’s information and contact numbers and immediately call 937 to see directions required to transfer the case to the hospital.
- If a confirmed case is registered among a worker, it is necessary to refer to the protocols of the MOH and the Saudi Center for Disease Prevention and Control (SCDC) in dealing with confirmed cases of the emerging corona disease (COVID-19).
- Allocate special rooms for isolation in the event that one of the workers is suspected to be infected with COVID-19 until contacting the competent authorities.
- Must adhere to the use of personal protection measures such as wearing surgical masks and medical gowns when dealing with new arrivals.
- Health practitioners and workers should wear face shields and gloves, as well as surgical sleeves and robe only if dealing with suspected cases among new arrivals.
- Health workers in the nursing homes should be competent to work in only one center and reduce their movement between homes or other health centers.
When a previously infected case with coronavirus enters into the nursing homes as a new arrival
Or was transferred to the center after being treated and recovered
- The return of the elderly to the nursing home after receiving treatment should be appropriately done through their doctor’s evaluation before transferring them as follows:
- If the case is confirmed and it has not fully recovered from the virus yet, it must not be transferred to the nursing home until it has fully recovered.
- If the case is confirmed and it has recovered from the virus, it can be received in the regular care department at the center after the evaluation of the infection control department at the hospital and the health staff in the center.
- If the case has tested negative but still have symptoms, they can be hospitalized in the regular care department at the center, but only if it is isolated in a private room where the isolation requirements are met
- COVID-19 laboratory testing is not required for all new arrivals or referrals to the nursing homes.
- The confirmed COVID-19 cases must be isolated for at least 14 days before being transferred to the common rooms in the nursing homes
- For new elderly people whose case is unknown and who do not have COVID-19 symptoms, they should be isolated in a single room for 14 days or tested if possible to ensure that they are free of the virus.
In the event of a confirmed or suspected case among the elderly, COVID-19 laboratory test must be performed
And that depends on the availability of capabilities and this includes the following:
- Test all elderly and workers in the nursing home,
- Or test only the workers and elderly in the department, where the confirmed case was, if it is not possible to test all workers and residents,
- Or test the escorts in the same room and the health personnel that were in contact with the confirmed or suspected case if it is not possible to test everyone in the department.
- If there is more than one suspected case and there are not enough isolation rooms, they can be placed in the same room while taking precautions between them so that the infection does not spread to uninfected individuals.
- The infected individual should be isolated inside a well-ventilated single room with the implementation of droplet and contact precautions. In the case of any spray action, airborne precautions are applied. If there is no single room, the isolation can be carried out in a collective room, but it should only be for confirmed/positive cases.
- Warn the residents to not leave their rooms in the event of a suspected or confirmed case, and in case of necessity, they must wear a surgical mask.
- All workers and elderly must be monitored daily with a question about their temperature, respiratory symptoms, and other symptoms for 14 days after registering a confirmed case.
Regarding the elderly who have memory problems or Alzheimer’s disease
- It may not be helpful to ask them the question about temperature and respiratory symptoms. Thus, in case of suspicion, a laboratory test must be done to ensure that they are free of the virus.
- A section should be allocated to them provided that each elderly person is in a private room, due to their inability to apply social distance protocols and their difficulty in understanding the guidelines.
- It should be noted that mood swings and deterioration of the memory may be associated with COVID-19, so they must be tested for the virus upon noticing these symptoms.
- Avoid changing the daily routine when they are diagnosed with COVID-19, so it would not lead to a deterioration of their mental health and difficulty in their treatment.
Communication and Awareness
- Visitors, workers and the elderly should be educated about coronavirus (COVID-19) and the precautionary measures that must be taken by making them aware of the following:
- Definition of the virus, its ways of transmission, its symptoms and the necessity of disclosing it.
- How to prevent themselves from COVID-19, including awareness of the importance of hand washing and sanitizing, and the use of masks and other means of protection.
- Adhere to hygiene and cough etiquette an covering their mouth or nose by using paper tissues or coughing into their elbow.
- Awareness posters must be displayed in the centers and in various locations.
- Health care and personal care providers must be educated and trained.
- The elderly should be encouraged to wear a mask in the absence of health problems and aware them of its importance.
- The infection control section in the nursing homes should develop a plan to receive new arrivals and how to deal with them in relation to COVID-19.
- An infection control officer must be present to oversee the nursing homes.
- Promote the physical, psychological and social health of residents in the nursing homes and provide appropriate healthy meals according to their health conditions.
- Preventive and rehabilitative health programs for the elderly should be organized and applied.
- The health monitoring of residents with chronic diseases must continue to be organized and coordinated with the specialized clinics in rescheduling appointments and dispensing prescription medicines.
- The health services that can be offered in the nursing homes must be supported and provided.
- Health requirements must be followed in the workers’ housing.
- A trained employee must be assigned to follow up the infection control tasks in each nursing home to monitor infection and the application of the precautionary measures.
- Develop alternative plans in the event of a shortage of health personnel and practitioners due to absence or illness to ensure business continuity with high efficiency.
Appendix A: Individuals who are at Higher Risk of Infection
The health controls for suspending attendance at workplaces during the Covid-19 pandemic shall be attached to the medical reports of the below Health Conditions:
- Those over the age of 65 years
- Chronic lung disease, or severe asthma:
For those who have been admitted to the hospital at least once in the past six months.
- Chronic heart diseases:
– Heart muscle failure.
– Coronary artery disease with at least having one heart attack during the past year.
- Inherited Immunodeficiency diseases
- Acquired Immunodeficiency:
1. Acquired immunodeficiency disease
2. Use of immunosuppressive drugs.
3. Use of cancer treatment drugs.
- Chronic medical conditions:
4. Uncontrolled diabetes, which necessitated admission to the hospital at least once during the past six months
5. High blood pressure disease, which required admission to the hospital at least once during the past six months
6. Kidney failure (dialysis)