Health & Human services

ACUTE CARE HOSPITAL (ACH) COVID-19 Guidance 

Summary of Recent Changes 

To order more tests from LAC DPH, please fill out this form: COVID-19 Antigen Test Request Form

General COVID-19 Prevention Guidance

Isolation separates persons with COVID-19 from others who are not infected with COVID-19. COVID-19 isolation measures for ACHs includes restricting the patientinto their room, infected patients wearing well-fitting masks indoors when not in their rooms, and staff donning full personal protective equipment (PPE) prior to entering isolation room or providing care (i.e., placing on transmission-based)precautions).

Entry Screening  

• Promptly test any newly symptomatic patients and patients who are exposed to a suspected or confirmed case during their hospital stay (CDC Guidance).
• Allaff should be educated to perform passive screening prior to entry
• Prior to visiting a patient in isolation, visitors should be advised of their possible exposure risk and other infection prevention practices that should be followed (i.e., PPE use, hand hygiene, physical distancing). 

Facilities should post visual alerts (e.g., signs, posters) at the entrance and in strategic places (e.g., waiting areas, elevators, cafeterias). These alerts should include instructions about current IPC recommendations (e.g., when to use source control). Facilities should communicate entry screening requirements and infection prevention and control measures regularly.  

Screening Patients 

• Remind patients to report any new COVID-19 symptoms to staff. Staff should be observing patients for signs and symptoms of COVID-19. 
• All patients should be assessed for symptoms and have vital signs recorded including temperature and oxygen saturation, at least once a day. More frequent monitoring is recommended for patients who are identified as close contacts (e.g., during shift changes) and patients with confirmed COVID-19 (e.g., every 4 hours). 

Hand Hygiene and Respiratory Etiquette

• Wash hands often with soap and water or alcohol-based hand rub (ABHR) that contains at least 60% alcohol for at least 20 seconds, especially after blowing your nose, coughing, or sneezing.  
• Provide adequate supplies for good hand hygiene, including easy access to clean and functional handwashing stations, soap, paper towels, and alcohol-based hand sanitizer (especially near entrances, food areas, and restrooms).  
• Educate and remind patients and staff to perform proper hand hygiene throughout the day, particularly after using the restroom and prior to eating their meals.  
• Educate patients and staff to cover coughs and sneezes with a tissue, and then dispose of the tissue and clean hands immediately. If you do not have a tissue, use your sleeve (not your hands).  
• Use soap and water to wash hands once they become visibly soiled or if a patient/patient has an infection that is not effectively killed by ABHR such as C.diff or Norovirus. It is also recommended to use soap and water especially after going to the bathroom and before eating. 
• Minimize, where possible, close contact and the sharing of objects such as cups, utensils, and food.  
  

Universal Source Control 

• HCP who have not obtained the annual influenza vaccine and/or the updated COVID-19 vaccine (2024-2025 formula) must continue to wear a well-fitting respiratory mask in patient care areas for the duration of the respiratory virus season (typically ending 4/30).
• All patients must be provided with a clean mask upon request.  
• Medical grade surgical/procedure masks, if tolerated, should be worn by any patient that is confirmed or suspected to have COVID-19.  
• Patients who, due to underlying cognitive or medical conditions, cannot wear masks, should not be forcibly required to wear one (and should not be forcibly kept in their rooms). However, masks should be encouraged as much as possible indoors in patient care areas.  
• A mask should not be placed on anyone who has trouble breathing, or is unconscious, incapacitated, or otherwise unable to remove it without assistance. Face shields or face shields with a drape may be offered to patients who are not able to wear masks.  
• During active COVID-19 outbreaks, all HCP and visitors should wear a well-fitting mask in patient care areas for the duration of the outbreak. Public health may require more stringent masking requirements based on the status and extent of the outbreak.   
  
  

Enhanced Cleaning & Disinfection   

Cleaning and disinfecting surfaces in facilities is highly important, although the risk of getting the virus by touching a contaminated surface is thought to be low. In most situations, cleaning is enough to reduce risk, however disinfectants further lower the risk of spreading COVID-19 by using chemicals to kill germs. All communal, high touch surfaces should be cleaned and disinfected routinely when not in an outbreak and increase frequency of cleaning and disinfection during an outbreak. Examples: doorknobs, phones, bannisters and railings, countertops, and faucet handles. For additional information on enhanced cleaning and disinfection recommendations please visit the CDC Guideline for Disinfection and Sterilization in Healthcare Facilities .

Remember: 

• Change cleaning cloths between rooms 
• Work from cleaner to dirtier surfaces 
• Work from high to low, top to bottom 
• A surface must be physically cleaned before it can be disinfected 
• Practice hand hygiene regularly
• Use EPA-registered disinfectants that have qualified for use against SARS-CoV-2 

Definitions: 

• Cleaning: removal of all visible and invisible soil and foreign material - for instruments, rinsing and/or using an enzymatic detergent per manufacturer's instructions for Use (IFU)
• Disinfection: destruction of nearly all pathogenic microorganisms on a non-living surface 
• Sterile/Sterilization: completely devoid of all microorganisms; the process by which bacteria, viruses, spores, and fungi are destroyed
• Instructions for use (IFU): manufacturer’s instructions for cleaning, disinfection, and sterilization of their equipment or product. Using disinfectants not on the IFU could void the warranty or cause irreparable damage. Must check for the latest version of the IFU.
• Wet or contact time: is the time required for a disinfectant to kill microorganisms on a pre-cleaned surface. Disinfectant must remain wet on the surface long enough to achieve the claimed level of surface disinfection. Follow manufacturer’s guidelines for achieving the appropriate wet contact time. 

COVID-19 Vaccination  

Vaccination is the best way to protect against COVID-19.  COVID-19 vaccines are safe and effective, especially against becoming seriously ill, being hospitalized and dying. Being up to date for COVID vaccines is very important for older adults. Older adults (especially those ages 50 years and older, with risk increasing with age) are more likely to experience complications such as hospitalization or death. COVID-19 vaccines may be administered along with and on the same day as other vaccines, such as the flu vaccine. Administer each injection in a different injection site. For more information, see Interim Clinical Considerations for Use of COVID-19 Vaccines.  

• CDC recommends that everyone age 6 months and older receive the most recent formulation of the COVID-19 vaccine.
• Stay Up to Date with COVID-19 Vaccine (CDC) Guidelines 

Antiviral Treatment

Diagnostic Testing for Symptomatic Individuals

Patients or staff with signs or symptoms of COVID-like illness, regardless of vaccination status, should be: 

1. Isolated immediately (i.e., HCP sent home, patient remain in current room on transmission-based precautions)
2. Tested immediately*
3. If first test was antigen and negative, test again 48 hours after first test  

Isolation & Quarantine

If targeted response testing yields positives, ACHs should expand testing of staff and patients to unit-wide or facility-wide routine testing. The minimum frequency of group-level response testing is at least once weekly for molecular testing (PCR) or twice per week for antigen (rapid) testing. More frequent testing above this minimum frequency may be an effective strategy to curb transmission. Testing must continue until there have been 14 days without patient cases.

Isolation separates sick people with a contagious disease from people who are not sick.  

• Staff/HCP: HCP regardless of vaccination status may discontinue isolation after 5 days (day 6 and beyond) with at least one negative diagnostic test same day or within 24 hours prior to return OR 10 days without a viral test. (AFL 21-08) Staff who are permitted to return to work before day 10 must continue to wear a well-fitting mask while at work others, including non-patients, at least through day 10.
• Patients: Positive patients must be isolated in a private room or placed together with other positive patients in a separate unit/hall/section/building designated as a 'COVID-19 isolation area'. Isolation may be discontinued for positive patients until at least 10 days** have passed since symptom onset; AND at least 24 hours have passed since resolution of fever without the use of fever-reducing medications; AND other symptoms have improved. (CDC Guidance)    

• Staff/HCP: No work restriction with negative diagnostic test upon identification (but not earlier than 24 hours after exposure) and if negative, test at days 3 and 5.  
• Patients: Patients who have been exposed via a COVID-positive roommate or staff member who had close contact, will need to wear a mask when outside of their room for 10 days following last exposure, but do not need to be placed in quarantine, restricted to their room, or cared for by staff using full PPE.  

***If a facility experiences critical staffing shortages due to a respiratory virus outbreak, facility should consult with LBDHHS to discuss prioritization of staff placement. 

Steps for Reporting Outbreaks

ACHs must report newly identified COVID-19 cases promptly (within 24 hours) to the Long Beach Department of Health and Human Services.  

• Create an emergency plan which includes steps required following the identification of a COVID-19 positive individual in the facility. Ensure this plan is kept up to date by referencing local, state, and federal guidance.  
• Put your emergency plan into action to protect your staff and patients. Do not wait for guidance from the health department to respond to the case.   
• Post information and keep your staff and patients informed about public health recommendations to prevent disease spread and about changes to services that might be related to the case.   
• Implement testing strategies (see testing guidance above) and isolation protocols for patients and staff (see isolation and quarantine guidance above.   
• Stagger breaks and rearrange seating in common break areas to maintain at least 6 feet physical distance between workers.Move or reposition workstations or identify more charting areas to allow for more physical distance. 
• Cohort all COVID positive patients on a dedicated COVID isolation area and if possible have dedicated nursing staff and environmental services staff. Cohort other ancillary staff (e.g., respiratory therapy, phlebotomy, radiology to the extent possible). Use disposable equipment or dedicate re-usable equipment to the unit and ensure cleaning/ disinfection between patient use using List N disinfectant. 
•  Ensure staff wear appropriate personal protective equipment (PPE) when working with patients in isolation (gown, gloves, N95 or higher level respirator, and face shield or goggles)  
• Ensure that all common areas within the facility follow frequent and effective practices for cleaning and disinfection.  
• If an outbreak investigation is opened for the facility, comply with public health requests for line lists, vaccination records, and any other requests. Line lists should be updated and sent after testing is conducted and results are received. Any documents with patient information need to be sent with encryption, locked with passcode, or sent via fax 562-570-4374. 
• Outbreaks can be cleared after 14 days with no new patient cases. 

• COVID-19 Symptoms

  People with COVID-19 have had a wide range of symptoms ranging from mild symptoms to severe illness. Please note adults over the age of 65 may have atypical symptoms such as lack of fever, new or worsened confusion, falls, and loss of appetite.  

  Symptoms of COVID-19 may include some combination of the following:   

  • Fever (100.4 F or higher)  
  • Cough  
  • Shortness of breath or difficulty breathing  
  • Chills  
  • Fatigue 
  • Muscle or body aches 
  • Headache  
  • New loss of taste or smell  
  • Sore throat  
  • Congestion or runny nose  
  • Nausea or vomiting  
  • Diarrhea 

  Please note: This list of symptoms is not all-inclusive.  

• COVID-19 Case

  A person who has received a positive result of the presence of SARS-CoV-2 virus as confirmed by a COVID-19 viral test or clinical diagnosis.​  

• Close Contact

  Close Contact means the following: 

  1. In indoor spaces of 400,000 or fewer cubic feet per floor (such as homes, clinic waiting rooms, airplanes, roommate etc.), close contact is defined as sharing the same indoor airspace for a cumulative total of 15 minutes or more over a 24-hour period (for example, three individual 5-minute exposures for a total of 15 minutes) during a confirmed case's infectious period. 
  2. In large indoor spaces greater than 400,000 cubic feet per floor (such as open-floor-plan offices, warehouses, large retail stores, manufacturing, or food processing facilities), close contact is defined as being within 6 feet of the infected person for a cumulative total of 15 minutes or more over a 24-hour period during the confirmed case's infectious period. 

  Spaces that are separated by floor-to-ceiling walls (e.g., offices, suites, rooms, waiting areas, bathrooms, or break or eating areas that are separated by floor-to-ceiling walls) must be considered distinct indoor airspaces. 

• Facility-acquired

  Surveillance and investigation of potentially hospital-acquired cases in healthcare providers (HCP) or patients per AFL 20-75.1:

  • Onset or diagnosis of COVID-19 in a patient occurring ≥ 7 days after admission (late- Dx COVID-19). Of note, onset of SARS-CoV-2 infection after a shorter period (e.g., ≥ 2 days) could still indicate hospital-associated transmission.
  • Two or more SARS-CoV-2 infections identified among epidemiologically linked HCP or patients (e.g., those working or residing on the same unit).

• Epidemiologically-linked:

  A case in which the individual has/has had contact with one or more persons who have/had COVID-19, and transmission of the agent by the usual modes of transmission is plausible. 

  Among Patients:

  Epi-linkage among patients is defined as overlap on the same unit or ward, or having the potential to have been cared for by common HCP within a 7-day time period of each other. 

  Among HCP:

  Epi-linkage among HCP is defined as having the potential to have been within 6 feet for 15 minutes or longer while working in the facility during the 7 days prior to prior to the onset of symptoms; for example, worked on the same unit during the same shift 

• Isolation

  Isolation separates persons with COVID-19 from others who are not infected with COVID-19. COVID-19 isolation measures for SNFs includes keeping the resident to their room, infected residents wearing well-fitting masks indoors when not in their rooms, and staff donning full personal protective equipment (PPE) prior to entering isolation room or providing care (i.e., placing on transmission-based precautions).