28 Apr UPDATED 4/28/20: OPWDD issues revised staff guidance for managing COVID-19

Posted at 13:17h in News by

On  April 28, OPWDD released “Revised Staff Guidance for the Management of Coronavirus (COVID-19) in Facilities or Programs Operated and/or Certified by the Office for People with Developmental Disabilities.”

The guidance addresses the following topics (click to jump to section):

More information on the NYS Department of Health (DOH) and the Center for Disease Control and
Prevention (CDC) recommendations can be found at:

  • DOH: https://coronavirus.health.ny.gov/home
  • CDC: https://www.cdc.gov/coronavirus/2019-ncov/index.html

A. Visitation and Community Outings

All visitation remains suspended for all OPWDD settings, except when medically necessary (i.e. visitor is essential to the care of the individual or is providing support in imminent end-of-life situations), for family members of individuals in imminent end-of-life situations, or those providing Hospice care. Community outings should be minimized to only those that are medically necessary and as limited in number and duration as possible. Facilities must provide other methods to meet the social and emotional needs of individuals, such as video calls. Facilities shall post signage notifying the public of the suspension of visitation and proactively notify individuals’ family members.

B. Staffing Health Checks for All Settings

Health checks should be implemented for all direct support professionals and other facility staff at the
beginning of each shift, and every twelve hours thereafter. This includes all personnel entering the
facility, regardless of whether they are providing direct care to individuals. This monitoring must
include a COVID-related symptom screen and temperature check. The site should maintain a written
log of this data.

All facility staff with relevant symptoms or with a temperature greater than or equal to 100.4 F should
immediately be sent home and quarantined until test results, or presumptive diagnosis, is obtained.
All staff who have worked in close proximity with the presumed infected staff member, in addition to
all individuals living in the residential setting, should also be quarantined.

C. When there are Suspected or Confirmed Cases of COVID-19

The following steps must be taken when any individual living in a residential facility, certified or
operated by OPWDD, is identified as having a suspected or confirmed case of COVID-19:

  1. Notify the local health department and the OPWDD Incident Management Unit, in accordance
    with “OPWDD Guidelines for Implementation of Quarantine and/or Isolation Measures at StateOwned and Voluntary Providers in Congregate Settings,” issued March 11, 2020.
  2. All individuals in the residential setting should be placed in quarantine and all affected
    individuals should remain in their rooms. Cancel group activities and communal dining. Offer
    other activities for individuals in their rooms to the extent possible, such as video calls.
  3. All staff working at the facility, who have had contact with the individual, should maintain
    quarantine in accordance with the “COVID-19 Protocols for Direct Support Personnel to Return
    to Work”, issued March 28, 2020. Impacted staff members must, remain quarantined in their
    home when not at work.
  4. Do not float staff between units or between individuals, to the extent possible. Cohort
    individuals with suspected or confirmed COVID-19, with dedicated health care and direct care
    providers, to the extent possible. Minimize the number of staff entering individuals’ rooms.
  5. Staff must actively monitor all individuals in affected homes, once per shift. This monitoring
    must include a COVID-related symptom screen and temperature check. The site should
    maintain a written log of this data for later review. If the individual’s symptoms worsen, notify
    their healthcare provider that the individual has suspected or confirmed COVID-19. If the
    individual has a medical emergency and you need to call 911, notify the dispatch personnel
    that the individual has, or is being evaluated for, COVID-19.
  6. Other individuals living in the home should stay in another room, or be separated from the sick
    individual, as much as possible. Other individuals living in the home should use a separate
    bedroom and bathroom, if available.

Make sure that shared spaces in the home have good air flow, such as by an air conditioner or an
opened window, weather permitting.

D. Additional Staffing Practices with Suspected or Confirmed Cases of COVID-19

All settings certified or operated by OPWDD should continue to implement the following staffing
considerations, to the extent possible:

1) Maintain similar daily staff assignments into or out of sites that serve individuals with a
confirmed or suspected diagnosis of COVID-19.

2) Limit staff assignments into or out of sites that serve individuals who had contact with a person
with a confirmed or suspected diagnosis of COVID-19.

3) Assign staff to support asymptomatic individuals with a confirmed or suspected diagnosis of
COVID-19.
a. If the individual with a confirmed exposure begins to show signs and symptoms consistent with COVID-19, those exposed staff should not be reassigned to other sites.

4) Any staff member showing symptoms consistent with COVID-19 should be directed to stay
home, or if the symptoms emerge while at work, sent home immediately.

E. Hand Washing

Handwashing is the most effective strategy for reducing the spread of COVID-19. Proper handwashing saves lives at work and at home.

Germs can spread from other people or surfaces when you:

  • Touch your eyes, nose, and mouth with unwashed hands;
  • Prepare or eat food and drinks with unwashed hands;
  • Touch a contaminated surface or objects; or
  • Blow your nose, cough, or sneeze into your hands and then touch other people’s hands or
    common objects.

When to Wash Hands: Direct support professionals and other facility staff should perform hand
hygiene before and after all individual contact, contact with potentially infectious material, and before
donning (putting on) and after doffing (removing) PPE, including gloves. Hand hygiene after doffing
PPE is particularly important, to get rid of any germs that might have been transferred to bare hands
during the removal process.

You can help yourself and your loved ones stay healthy by washing your hands often, especially
during these key times when you are likely to get and spread germs:

  1. When starting work;
  2. Before handling medications;
  3. Before assisting individuals with personal hygiene (toileting, bathing, shaving, menstrual care,
    wound care, etc.);
  4. After assisting with personal hygiene tasks;
  5. Before, during, and after preparing food;
  6. After using the bathroom;
  7. After coughing, sneezing, or smoking;
  8. Before donning disposable gloves;
  9. After doffing disposable gloves;
  10. After touching garbage;
  11. After touching an animal, animal feed, or animal waste;
  12. After handling pet food or pet treats; and
  13. Before leaving work.

During the COVID-19 public health emergency, you should also clean hands:

1) After you have been in a public place and touched an item or surface that may be frequently
touched by other people, such as door handles, tables, gas pumps, shopping carts, or
electronic cashier registers/screens, etc.

2) Before touching your eyes, nose, or mouth.

How to Wash Hands: Follow Five Steps to Wash Your Hands the Right Way: Washing your
hands is easy, and it’s one of the most effective ways to prevent the spread of germs. Clean hands
can stop germs from spreading from one person to another and throughout an entire community—
from your home and workplace to childcare facilities and hospitals.

Follow these five steps every time.

1. Wet your hands with clean, running water (warm or cold), and apply soap.

2. Lather your hands by rubbing them together with the soap. Lather the backs of your hands,between your fingers, and under your nails.

3. Scrub your hands for at least 20 seconds.

4. Rinse your hands well under clean, running water.

5. Dry your hands using a clean towel or air dry them.

All facilities should ensure that hand hygiene supplies are readily available to all personnel in
every care location.
Every staff member, whether they are involved in direct support tasks or not, is encouraged to watch
the CDC training videos on handwashing, available at https://www.cdc.gov/handwashing/index.html.

F. Use of Hand Sanitizer

Washing hands with soap and water is the best way to get rid of germs. However, if soap and water
are not readily available, you can use an alcohol-based hand sanitizer that contains at least 60%
alcohol. You can tell if the sanitizer contains at least 60% alcohol by looking at the product label.
Staff should perform hand hygiene by using hand sanitizer containing at least 60% alcohol or washing
hands with soap and water for at least 20 seconds. If hands are visibly soiled, use soap and water.
Sanitizers can quickly reduce the number of germs on hands in many situations. However,
• Sanitizers do not get rid of all types of germs.
• Hand sanitizers may not be as effective when hands are visibly dirty or greasy.
• Hand sanitizers might not remove harmful chemicals from hands like pesticides and heavy
metals.
How to use hand sanitizer
• Apply the gel product to the palm of one hand (read the label to learn the correct amount).
• Rub your hands together.
• Rub the gel over all the surfaces of your hands and fingers until your hands are dry. This
should take around 20 seconds
Access to Hand Sanitizer
Hand sanitizer should be readily available throughout the residential setting. At a minimum, there
should be a hand sanitizer station near the front door of the facility, in the kitchen/dining room, and in
the living room/common room, if one exists. Hand sanitizer should be present at the bedroom door of
each individual. If staff are not wearing gloves, staff should use hand sanitizer whenever they enter or
exit an individual’s bedroom. To the extent that individuals in the home are at risk of ingesting the
hand sanitizer, or engaging in other unsafe behaviors with it, the location of hand sanitizer throughout
the residential facility may need to be modified, or staff may need to carry refillable pocket size hand
sanitizers on their person.

G. Environmental Hygiene

The transmission of the COVID-19 virus can be reduced by maintaining a germ-free environment.
The following measures should be taken at all facilities:
• Clean all “high-touch” surfaces, such as counters, tabletops, doorknobs, bathroom fixtures,
toilets, phones, keyboards, tablets, and bedside tables, every shift. Bedroom and bathroom
doorknobs are prime locations for germ transmission.
• Clean any surfaces that may have blood, stool, or body fluids on them. Use a household
cleaning spray according to the label instructions. Labels contain instructions for safe and
effective use of the cleaning product, including precautions you should take when applying the
product, such as wearing gloves and making sure you have good ventilation during use of the
product.
• If the residence requires the use of a shared bathroom, bathroom surfaces must be cleaned
after every use.
• Avoid sharing household items with the individual. Individuals should not share dishes, drinking
glasses, cups, eating utensils, towels, bedding, or other items. After the individual uses these
items, wash them thoroughly.
• Wash laundry thoroughly. Immediately remove and wash clothes or bedding that have blood,
stool, or body fluids on them.
• Staff should wear disposable gloves while handling soiled items and keep soiled items away
from the body. Staff should clean their hands with soap and water or an alcohol-based hand
sanitizer immediately after removing gloves.
• Read and follow directions on labels of laundry or clothing items and detergent. In general, use
a normal laundry detergent according to washing machine instructions and dry thoroughly
using the warmest temperatures recommended on the clothing label.
• Place all used disposable gloves, facemasks, and other contaminated items in a lined
container before disposing of them with other household waste. Staff should clean their hands
with soap and water or an alcohol-based hand sanitizer immediately after handling these
items. Soap and water should be used if hands are visibly dirty.
• Staff should discuss any additional questions with their supervisor or assigned nursing staff or
contact the state or local health department or healthcare provider, as needed. Check
available hours when contacting the local health department.

H. Individual Placement

Maximal effort should be made to separate individuals who are either infected or presumed to be
infected with COVID-19, from those who are thought not to be infected. When hospitalization is not
medically necessary, care in the home must be provided as safely as possible and should consider
the following:
• If possible, move an individual with COVID-19 to a separate cohorted setting, potentially in a
different location or home.
• Whenever possible, place an individual with known or suspected COVID-19 in a single-person
room with the door closed. If possible, the individual should have a dedicated bathroom.
• As a measure to limit staff exposure and conserve PPE, agencies could consider designating
entire programs within the agency, with dedicated staff, to care only for individuals with known
or suspected COVID-19.
• Determine how staffing needs will be met as the number of individuals with known or
suspected COVID-19 increases and staff become ill and are excluded from work.
Please note that it might not be possible to distinguish individuals who have COVID-19 from
individuals with other respiratory viruses. As such, individuals with different respiratory viruses will
likely be housed together.

I. Personal Protective Equipment

PPE is used by healthcare personnel, including direct support staff and clinicians, to protect themselves, individuals, and others, when providing care. PPE helps protect staff from potentially infectious individuals and materials, toxic medications, and other potentially dangerous substances used in healthcare delivery. However, PPE is only effective as one component of a comprehensive program aimed at preventing the transmission of COVID-19. Facilities and programs should consult the Centers for Disease Control and Prevention (CDC) guidance to optimize the supply of PPE and equipment through conventional, contingency, and crisis strategies at
https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/index.html.

When Caring for Individuals who are NOT Infected with or Presumed to be Infected with COVID-19:
Consistent with current practice, all staff are instructed to wear a facemask, at all times, while at work.
This is intended to reduce COVID-19 transmission from potentially infected staff, who may be
asymptomatic. While at work, the facemask will be standard PPE.
When Caring for Individuals who are Infected with or Presumed to be Infected with COVID-19:
Individuals confirmed or suspected of having COVID-19 should wear a facemask when around other
people, unless they are not able to tolerate wearing one (for example, because it causes trouble
breathing). Staff should always wear a mask when in the same room as that individual.
Staff should perform hand hygiene before and after all individual contact, contact with potentially
infectious material, and before donning and doffing PPE, including gloves. Hand hygiene after
removing PPE is particularly important to get rid of any germs that might have been transferred to
bare hands during the removal process.
The PPE protocol recommended when caring for an individual with known or suspected COVID-19
includes:
• Facemasks
o Put on facemask upon entry into the group home, and wear at all times while in the
work setting.
o As needed, implement extended use of facemasks. Wear the same facemask for
multiple individuals with confirmed COVID-19 without removing between individuals.
Change only when soiled, wet, or damaged. Do not touch the facemask.
o If necessary, use expired facemasks.
o Prioritize facemasks for staff rather than as source control for individuals. Have
individuals use tissues or similar barriers to cover their mouth and nose. Assist
individuals with this as needed.
o If necessary, implement limited re-use of facemasks. Do not touch outer surface of
facemask. After removal, fold so that outer surface in inward and store in breathable
container, such as a paper bag, between uses. This facemask should be assigned to a
single staff member. Always perform hand hygiene immediately after touching the
facemask.
o When splashes or sprays are anticipated, use a face shield covering the entire front and
sides of the face. Use goggles if face shields are not available.
o The use of cloth masks, or other homemade masks (e.g., bandanas, scarves), for
clinical and direct support staff providing direct care to individuals, is not recommended.
o For further information, consult the CDC guidance entitled “Strategies for Optimizing the
Supply of Facemasks”, available at https://www.cdc.gov/coronavirus/2019-
ncov/hcp/ppe-strategy/face-masks.html.
• N95 Respirators
o All staff wearing N95 respirators should undergo medical clearance and fit testing.
o N95 Respirators offer a higher level of protection and should be worn, if available, for
any aerosol-generating procedures or similar procedures where there is the potential for
uncontrolled respiratory secretions.
o As needed, implement extended use of N95 respirators. Wear the same respirator for
multiple individuals without removing between individuals. Change only when soiled,
wet, damaged, or difficult to breathe through. Do not touch the respirator.
o If necessary, use expired N95 respirators; refer to CDC guidelines entitled “Release of
Stockpiled N95 Filtering Facepiece Respirators Beyond the Manufacturer-Designated
Shelf Life: Considerations for the COVID-19 Response”, available at
https://www.cdc.gov/coronavirus/2019-ncov/hcp/release-stockpiled-N95.html.
o If necessary, implement limited re-use for individuals with COVID-19, if possible with
decontamination between uses; refer to FDA guidance entitled “Personal Protective
Equipment Emergency Use Authorization”, available at https://www.fda.gov/medicaldevices/emergency-situations-medical-devices/emergency-useauthorizations#covid19ppe. In addition to the approved method, refer to CDC guidance
entitled “Decontamination and Reuse of Filtering Facepiece Respirators using
Contingency and Crisis Capacity Strategies”, available at
https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/decontamination-reuserespirators.html. If not decontaminated, an important risk is that the virus on the outside
of the respirator might be transferred to the wearer’s hands, leading to transmission to
the health care personnel or other individuals. It is critical to avoid touching the
respirator while worn and during or after doffing and to perform rigorous hand hygiene.
Assign to a single staff person and store in a breathable container, such as a paper bag,
between uses. For further information consult the CDC guidance entitled
“Recommended Guidance for Extended Use and Limited Reuse of N95 Filtering
Facepiece Respirators in Healthcare Settings”, available at
https://www.cdc.gov/niosh/topics/hcwcontrols/recommendedguidanceextuse.html.
• Eye Protection
o Put on eye protection (i.e., goggles or a disposable face shield that covers the front and
sides of the face) upon entry to an individual’s room or care area. Personal eyeglasses
and contact lenses are NOT considered adequate eye protection.
o Remove eye protection before leaving the individual’s room or care area.
o Reusable eye protection (e.g., goggles) must be cleaned and disinfected according to
manufacturer’s reprocessing instructions, prior to re-use. Disposable eye protection
should be discarded after use.
• Gloves
o Put on clean, non-sterile gloves upon entry into an individual’s room or care area.
o Change gloves if they become torn or heavily contaminated.
o Remove and discard gloves when leaving the individual’s room or care area, and
immediately perform hand hygiene.
• Gowns
o Put on a clean isolation gown upon entry into an individual’s room or care area. Change
the gown if it becomes soiled. Remove and discard the gown in a dedicated container
for waste or linen when leaving the individual’s room or care area. Disposable gowns
should be discarded after use. Cloth gowns should be laundered after each use.
o If there are shortages of gowns, they should be prioritized for:
▪ Aerosol-generating procedures;
▪ Care activities where splashes and sprays are anticipated;
▪ High-contact individual care activities that provide opportunities for transfer of
germs to the hands and clothing of staff. Examples include:
▪ Dressing;
▪ Bathing/showering;
▪ Transferring;
▪ Providing hygiene;
▪ Changing linens;
▪ Changing briefs or assisting with toileting;
▪ Device care or use; and
▪ Wound care.

J. What to Do When PPE Supply is Low

Critical PPE needs should be communicated to the respective local Office of Emergency
Management, with the appropriate information provided at the time of request. Requests MUST
include:
• Type and quantity of PPE by size;
• Point of contact at the requesting facility or system;
• Delivery location;
• Date request is needed to be filled by; AND
• Record of pending orders.
Contingency strategies can help stretch PPE supplies when shortages are anticipated at a facility.
Crisis strategies can be considered during severe PPE shortages and should be used with the
contingency options to help stretch available supplies for the most critical needs. As PPE availability
returns to normal, healthcare facilities should promptly resume standard practices.
Facilities should review the following guidance on Strategies for PPE shortages:
OPWDD guidance issued April 6, 2020, available at
https://opwdd.ny.gov/system/files/documents/2020/04/4.6.2020-opwdd-memo-regarding-covid19-
ppeshortage_0.pdf.
CDC guidance regarding specific strategies for the conservation of facemasks, eye protection,
isolation gowns and N95 respirators is available at https://www.cdc.gov/coronavirus/2019-
ncov/hcp/ppe-strategy/index.html.
Staff are encouraged to download and use the following PPE posters from the CDC:
https://www.cdc.gov/coronavirus/2019-ncov/communication/factsheets.html#healthcare.
Facilities should also refer to the following documents for more information:
https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-prevent-spread.html.

K. ADDITIONAL RESOURCES
More information on the NYS Department of Health (DOH) and the Center for Disease Control and
Prevention (CDC) recommendations can be found at:
• DOH: https://coronavirus.health.ny.gov/home
• CDC: https://www.cdc.gov/coronavirus/2019-ncov/index.html

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