Persons experiencing homelessness may be at high risk for COVID-19
infection (see CDC
guidance), especially if they are having frequent close contact with others
in the community. Those people who are older or have chronic medical conditions
are at higher risk for serious illness if infected. Once identified as having
COVID-19 symptoms, a positive test, or close contact with someone known to have
COVID-19, these individuals should be prioritized for isolation in individual
housing units (e.g., hotel or motel rooms, trailers) or cohorted in group
settings with appropriate healthcare personnel and services. Individuals
without symptoms or known exposure and who are at higher risk for serious
illness due to age 65 years or older, or underlying chronic health condition,
may be offered housing to prevent their exposure to others. This document provides
guidance for safely operating these Project
Roomkey (PDF) sites once suitable sites have been identified in accordance with
California’s recommended protocol (PDF) and flowchart (PDF).
Determine in advance how to address all facility needs for opening the facility and providing all ongoing services. Prepare a written plan for all operations, covering all possible contingencies. Consider the following:
Implement procedures that follow CDC and CDPH guidance, and applicable Cal/OSHA regulations, for controlling and preventing COVID-19 infection. Some are described further in the sections below or in guidance listed under Resources. Ensure that communications and signage is offered to staff and clients in relevant languages and at appropriate literacy level. Address the following:
Staff personal protective equipment (PPE) needs are determined by job task and whether the employee must enter a room occupied by a COVID-19 patient or a Person Under Investigation (PUI) who has symptoms or has been exposed to a person who tested positive for COVID-19. To minimize reliance on the use of PPE, facilities should employ all possible engineering controls, such as physical barriers to create distance between staff and clients, and administrative controls, such as limiting the number of staff assigned to duties that require entry to patient rooms.
Facilities having difficulty procuring necessary PPE should contact their local health department's Medical Health Operational Area Coordinator (MHOAC).
During periods when respirators are not required, a procedure mask or surgical mask should be worn by all personnel as source control to limit the possible spread of COVID-19 from infected people who may not have symptoms. This practice is not considered PPE use because the covering provides an unknown level of protection to the wearer. Cloth face coverings in nonpatient/non-PUI areas may be used to conserve supplies of procedure or surgical masks.
In non-emergency conditions, employers must provide fit-tested, NIOSH-certified respirators to all employees occupationally exposed to novel pathogens such as SARS-CoV-2. However, for the current COVID-19 crisis, certain respirators from other countries or surgical masks may be used when the respirator supply is insufficient for anticipated surges or when efforts to optimize the efficient use of respirators do not resolve the respirator shortage. When supplies are limited, a single respirator may be worn for an extended period of time, for example while the wearer enters multiple patient rooms to clean or change linens. See guidance from Cal/OSHA (PDF) and CDC on managing respirator supply shortages.
Cloth gowns or other garments that cover the arms and body that can be safely laundered may be used as an alternative to disposable gowns. Disposable coveralls, also called bunny suits, can also be used where neither isolation gowns nor cloth gowns are available, as an alternative where specified below.
Eye protection is needed when staff are in patient care areas to prevent infection that may result from respiratory droplets contacting the eye. Either face shields or goggles may be used. If reusable eye protection is used, it must be cleaned and disinfected between uses.
All staff must be trained on the correct procedures for donning (putting on) and doffing (taking off) PPE, per CDC guidance. Fact sheets and posters are available on the CDC website. All required PPE should be donned before entering a client's room.
Establish procedures to routinely clean and disinfect commonly touched surfaces and objects (e.g., door knobs, touch screens, food preparation areas, bathrooms), including:
Using disinfectants that are EPA-approved for use against the virus that causes COVID-19.
Providing EPA-registered disposable wipes for staff to wipe down commonly used surfaces before and after use.
Following the manufacturer's instructions for all cleaning and disinfection products (e.g., safety requirements, protective equipment, proper dilution, contact time).
Following safe work practices such as never mixing products together and using adequate ventilation.
Cleaning visibly dirty surfaces first before disinfection. Disinfectants are less effective if used on soiled surfaces.
Ensuring there are adequate supplies to support cleaning and disinfection practices, including cleaning products and tools and chemical resistant gloves. Make sure disinfectants are available to workers throughout the worksite.
Staff collecting, sorting or handling soiled laundry and linens should wear PPE as described above. They should collect potentially contaminated laundry into bags or other appropriate containment that are clearly identified as "dirty" by labels or some other method, whether they are transported within the facility or to an off-site laundry service. For clients who can collect their own laundry, three different bags for clothing, towels and sheets may be labeled with the room number and clients instructed to fill them, seal with a knot and place outside the room door at a specified time. Bags need to be made of material with sufficient strength. They may be transported by cart or chute.
Oxygen-based bleach and detergents used in health care settings should be registered by EPA to ensure adequate disinfection of laundry. Hot water provides an effective means of destroying organisms; a temperature of at least 160°F/71°C for a minimum of 25 minutes is commonly recommended for hot-water washing. Dryer temperatures and cycles are dictated by the type of material and fabric. Disinfection of the laundry machines is unnecessary.