Updated guidelines for visitation in healthcare facilities

By Holly Carlson, MS, RN, CCRN

The race to reopen our cities from a pandemic that plagued the world for the past year has begun. The availability of vaccines, the steady decline in cases, and the decrease in deaths from COVID 19 has prompted law makers and experts to ease protective mandates.

To date there are:

• 2 states who have lifted all mandates and restrictions (Texas and Florida).
• 14 States who have lifted statewide restrictions but are following local protective mandates.
• 33 States that continue to have statewide restrictions.

These numbers will be fluid while vaccination numbers increase and expert recommendation come forward in response to the waning existence of COVID 19.

Occurrence Rates Impact Guidelines

The Centers for Disease Control (CDC) and the Centers for Medicaid and Medicare (CMS) have developed occurrence rates which reflect county infection rates. The occurrence rates determine what measures can be eased or which should be put back in place with “opening” and “closing” human contact. The occurrence ratings are divided into 3 categories based on the percentage of cases by population within a county:

• Low <5%
• Medium 5-10%
• High >10%

When Are Visitors Allowed?

On March 10, 2021, the Centers for Disease Control updated the infection prevention recommendations in response to the vaccination rates and disease prevalence. Capturing the details can be tricky in the busyness of the day so here are they are.

Non-Healthcare Persons in Non-Healthcare Settings:

Vaccinated Persons

• Inside gatherings can occur if all participants have been vaccinated.
• Do not need to wear masks during small gatherings or quarantine afterwards.
• Can visit low risk single household members indoors without using a mask or social distancing.
• Do Not have to quarantine or test following exposure if they are asymptomatic.
• Should continue to wear face masks and socially distance in public spaces.

Unvaccinated Persons

• Unvaccinated people should continue with prior protective measures.

Lastly, all people should avoid medium and large groups.

 

Post-Acute Care Settings:

       Unvaccinated

• No indoor visitation for UNVACCINATED residents in counties with COVID 19 rates greater than 10% and less than 70% resident vaccination rate.
• UNVACCINATED Residents should not engage in indoor visitation until two weeks after their vaccination (single dose or last dose of 2 step vaccine).
• If a resident has an unvaccinated roommate, they should be separated during the indoor visitation.

Vaccinated

• Risks of indoor visitation should be explained to the resident.
• Visitor and Resident should still wear a facemasks despite vaccination status.
• Social distancing should be maintained.
• Avid hand hygiene should continue to be a priority.
• Prolonged exposure to someone who is known to have COVID 19 should isolate for 14 days even if they have been vaccinated (prolonged exposure defined as: within 6 feet for 15 minutes or more within 24 hours).

Facility Responsibilities

• Visitor screening should continue.
• Facilities need a plan for managing visitor volume.
• New admissions to facilities should be vaccinated.
• New residents who were vaccinated prior to admission, do not need to be isolated.
• Testing and PPE guidelines remain unchanged.

Healthcare Providers

• Fully vaccinated providers do not need to isolate for 14 days if exposed.
• Vaccinated providers should continue to follow CDC guidelines for travel.

Centers for Medicare and Medicaid

CMS has additional guidelines that must be followed:

• The number of visitors must be limited at any given time i.e. 10 in the building at a time.
• Visitors must be screened upon arrival and monitored to limit movement within a facility.
• Visitation must have a time limit.
• Visitors can only come in the facility if county infection rates allow.
• Visitation may not be restricted when a facility has been infection free for 14 days and the county rate is medium or low.

Activities and Communal Dining:

• Residents are allowed to eat together but must maintain 6-foot distance.
• Group activities can occur and should be divided into groups: those who are immunized or recovered and those who are still vulnerable.
• All group activities must follow hand hygiene, face coverings, and social distancing practices.

The only exception to visitation rules is in cases where a Resident maybe experiencing emotional distress, life altering loneliness, grieving a person or pet, nearing the end of life, or are not adjusting to their new living environment.

How to Discontinue Precautions

Every resident who has been placed in isolation will need to be taken out of it safely. These are the guidelines for discontinuing isolation precautions:

• 10 days have past since symptoms first appeared.
• It has been 24 hours since the infected person has had a fever without using fever reducing medication (acetaminophen or ibuprofen).
• Symptoms have improved (they do not have to be gone).
• 2 negative nasal cavity tests 24 hours apart.

Immunocompromised People

It is important to note that Immunocompromised people can be contagious for up to 20 days. There are people who will shed the virus for many days if not weeks after they are symptom free. It is important to error on the side of precaution before exposing people who are not sick to those who are or have been.

In addition to the CDC and CMS guidelines, facilities who have a breakout are required to follow their local and state Department of Health guidelines. These guidelines do vary based on the climate of the state and local authorities. State specific requirements can be found on the websites of each state.

COVID 19 has created a lot of chaos in the last year, remaining diligent and following guidelines will allow us to move closer if not return to normal. Stay safe and be healthy!

Holly Carlson MS, RN, CCRN is a freelance writer and owner of HDC Consulting.  Holly is a registered nurse with 25 years of healthcare experience in both acute and post-acute healthcare environments. Her experience includes direct care, organizational leadership, facility management, and organization culture development.

References

Centers for Disease Control . (March 10,2021). Updated Healthcare Infection Prevention and Control Recommendations in Response to COVID-19 Vaccination. https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-after-vaccination.html

Department of Health & Human Services Centers for Medicare & Medicaid Services.  (March 10, 2021). Nursing Home Visitation-COVID-19-Revised. https://www.cms.gov/files/document/qso-20-39-nh-revised.pdf.