Guidance for Congregate Living Facilities

Interim Recommendations to Reduce Transmission of SARS-CoV-2 in Congregate Living Facilities: Universal Masking and Enhanced Environmental Disinfection

Purpose

This guidance provides universal masking and environmental disinfection recommendations for congregate living facilities in dealing with SARS-CoV-2, the virus that causes COVID-19.

Recommendation for Universal Masking Policy in Residential Congregate Living Facilities

Until further notice, the Illinois Department of Public Health (IDPH) recommends congregate living facilities serving vulnerable populations1 implement a universal-masking policy requiring all staff to wear a mask when working. This includes staff responsible for direct interaction or care involving residents and staff who do not normally interact directly with patients and residents, such as administrative, dietary, environmental services, and facility maintenance. Universal masking will reduce the risk of transmission from staff who may be carrying SARS-CoV2 but are asymptomatic. In addition, face masks are widely used as an important part of droplet precautions when caring for patients with respiratory infections.

The Centers for Disease Control and Prevention (CDC) has issued guidance regarding optimizing the supply of face masks, including extended use and reuse strategies: https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/face-masks.html.

Hand hygiene should be performed before putting on a mask, and after touching, adjusting, or removing a mask. Face masks should be removed and discarded if soiled, damaged, or hard to breathe through. Face masks with elastic ear hooks may be more suitable for re-use.

In the context of severe personal protective equipment (PPE) shortages, and only if surgical masks or respirators are not available, CDC has agreed home-made cloth masks can be used as a last-resort until  availability of standard PPE is restored. Homemade masks are not considered PPE.  Health care staff should wear N-95 respirators as appropriate, based on the type of patient care involved (aerosolizing procedures), per CDC guidance.

Additional information and resources about alternative face masks and universal masking are available from the Minnesota Department of Health and University of Nebraska. (Links to this guidance are below, as updates to these documents may occur.)

Guidance from the Minnesota Department of Health on alternative face masks: http://www.health.state.mn.us/diseases/coronavirus/hcp/masksalt.pdf

The University of Nebraska Policy on Universal Masking: http://www.nebraskamed.com/sites/default/files/documents/covid-19/surgical-mask-policy-and-faq-nebraska-med.pdf.

Recommendation for Enhanced Environmental Disinfection

In order to assist with efforts to interrupt transmission of SARS-CoV-2 via contaminated surfaces in residential congregate living facilities, IDPH recommends frequent environmental disinfection of surfaces frequently touched by occupants – at least three times per day or once per shift. When feasible, IDPH recommends use of a spray (no-wipe) product to facilitate application.

Common touchpoints include door knobs and door handles, door push bars, light switches and cover plates, telephones, reception desks and reception area furniture, elevator call buttons and cover plates, refrigerator door handles, TV remote controls, microwave buttons, breakroom tables and countertops, filing cabinet handles, stair and ramp hand railings, vending machine buttons, paper towel dispensers, soap dispensers, toilet seats, toilet and urinal flush handles, restroom door partition handles, workstation and office desktops, drawer pulls, keyboards and computer mice, and office equipment. Health care facilities will require cleaning of additional surfaces, including but not limited to wheelchair handles, IV poles, bed rails, nightstands, and nurse call buttons.

IDPH recommends selecting a disinfectant from the U.S. Environmental Protection Agency’s (EPA) list of disinfectants for use against SARS-CoV-2, known as the N-List, available on the  EPA website at https://www.epa.gov/pesticide-registration/list-n-disinfectants-use-against-sars-cov-2-covid-19. Follow manufacturer’s instructions for application and proper ventilation when using disinfectants. Dilutions should be performed according to written guidance from the manufacturer.

Ease of use, contact times, and safety (staff/patient/resident) concerns must be considered when selecting and using a disinfection agent. N-List products that can be sprayed, with a short contact time, (e.g., between 30 seconds and one minute as indicated on the label) and do not require wiping have potential advantages. Application of disinfectant may be facilitated by use of an industrial-style sprayer with the nozzle of the spray wand held close – 6 to 8 inches – to the surface to which disinfectant is being applied. Some products (e.g., sodium hypochlorite, household bleach, peracetic acid) pose increased inhalational risks, but a diluted solution of household bleach may be useful in some settings. 2 Depending on the disinfectant, it may be appropriate for residents to leave the room for a brief period where disinfectants are being used. Pre-cleaning may be required if surfaces are visibly dirty.

Consult the manufacturer’s instructions for cleaning and disinfection products used. Products should be used per manufacturer labelling, and the Safety Data Sheet for any product being used should be reviewed and readily available to employees. Wear disposable gloves when cleaning and disinfecting surfaces. Gloves should be discarded after each cleaning. If reusable gloves are used, those gloves should be dedicated for cleaning and disinfection of surfaces for COVID-19 and should not be used for other purposes. Clean hands immediately after gloves are removed.

IDPH does not recommend applying disinfection products using methods other than those described on the product labeling.

Last Updated:  6/24/2020