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Dr. Shari Ling:
Welcome to the first episode of a podcast series, "CMS Beyond the Policy: Nursing Home Series for Front Line Clinicians and Staff." I'm Dr. Shari Ling, Deputy Chief Medical Office for The Centers for Medicare and Medicaid Services and geriatrician. On behalf of my colleagues, let me begin with our heartfelt thanks to you. We know that you all are working incredibly hard to help combat the spread of COVID-19 within America's nursing homes and communities across the country. And we deeply appreciate your dedication of efforts to keep residents safe. We are launching this podcast series to provide key facts concisely that are the basis for practical and critical actions on the frontline. Today my CMS colleague, David Wright, Director of the Quality Safety & Oversight Group, is joining me to focus on a few questions that we have heard from our frontline staff. So, David, welcome. And if you could begin, would you say what are three important actions that every frontline clinician or caregiver can take to prevent the spread of COVID-19 within nursing homes today? That is right now.
David Wright:
Thanks, Shari. I'm glad to be here. And so, three things to really focus on: first is good source control through the use of face mask and all personal protective equipment or PPE. Second, it's been recommended. and we hope everyone continues to adhere to good hand hygiene with soap and water for a least 20 seconds or hand sanitizer that contains at least 60 percent alcohol. And third, it's important to have screening of staff and residents with appropriate actions taken for those who have screen positive, such as testing them additionally for COVID-19, excluding them from working, and placing residents on transmission-based precautions. I think one of the most important things for frontline staff to also remember is these practices are good inside the nursing home, but of equal importance when they're outside and in community to reduce the chance of community prevalence coming into the nursing home.
Dr. Shari Ling:
Excellent. Thank you, David. And so, it sounds like staff play a critical role in keeping COVID out as well as keeping COVID from spreading within nursing homes. And one of the issues we've heard about is about PPE. So, can you tell us what should frontline staff be doing to effectively manage the issue of PPE at this point?
David Wright:
Sure, through our onsite engagement with nursing homes both in our survey oversight and technical assistance that’s being provided, we've seen that it can be hard for staff to sort out which PPE they should be used, and when difficulty and appropriately donning and doffing PPE, including proper placement of the facemask or respirator. And also, again, making sure there is not contamination when taking the PPE off which includes making sure you do proper hand hygiene. One of the biggest things that we recommend staff do is help each other out. If they see another staff member maybe inappropriately wearing PPE or doing it in a way that's not going to provide the kind of protection for both the residents and staff that’s needed, offer to help them out and make sure that everyone is doing what that need to do all the time. We've also seen that staff, sometimes within nursing homes, when they go into a breakroom or outside for a break, sometimes then, don’t adhere to those protocols as well as they should. And it's important to remember that that protection is in place and needs to be in place at all times for both the staff and residents' safety. Nursing homes should review CDC infection prevention and control resources on the correct way to use PPE, steps and sequence of donning and doffing, and strategies to optimize their PPE. CDC even has a PPE burn rate calculator to help facilities plan in advance for their needs. When facilities are running low on PPE supplies, they should reach out to public health authorities for assistance, and should follow national and/or state and local guidance for optimizing their current supply.
Dr. Shari Ling:
David, thank you for joining me to start this important series. This information is critical and hopefully helpful to you, our listeners. And surely, more discussion will be warranted. To our frontline staff, please take advantage of the many resources available including additional Microcast episodes, online training, and frequent stakeholder calls. You can access these resources and more via our new nursing home resource center at www.cms.gov\nursing-homes. So, in closing, let me end where I began which was to say thank you for your dedication, and for your caring attention to nursing home residents across the country.
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