Strategy for Skilled Nursing Facilities: Targeted COVID-19 Testing and Cohorting Plan
The California Department of Public Health's Center for Health Care Quality (CHCQ) requires all skilled nursing facilities (SNFs) to develop a plan, in conjunction with CHCQ and their local health department, for regular testing of SNF residents and health care workers to limit exposure and prevent the spread of COVID-19 in the facility. The plan includes strategies for baseline, surveillance, and response-driven testing, and how test results will be used to inform resident and health care worker cohorting. A testing and cohorting plan is one of six elements included in the required SNF COVID-19 Mitigation Plans, as listed in All Facilities Letter 20-52. All Facilities Letter 20-53 expanded upon the testing elements of those plans.
SNFs conduct COVID-19 baseline testing for all residents and health care workers in any facility that does not currently have a positive case. Baseline testing is a point in time snapshot to detect cases in SNFs quickly, stop transmission, and implement effective infection prevention and control actions. Baseline testing, required as part of All Facilities Letter 20-55, was required by June 30, 2020.
Surveillance testing is conducted in SNFs that do not currently have any positive resident or health care worker cases identified on baseline testing. SNFs test 25 percent of health care staff weekly, to ensure that all SNF staff are tested once a month.
Response-driven testing is conducted in SNFs as soon as possible after COVID-19 positive resident(s) or health care worker cases are identified in the facility. SNFs conduct weekly retesting of all residents and health care workers who test negative upon initial testing until no new cases are identified in two sequential rounds of testing. SNFs resume their regular surveillance testing for HCW after no new positive cases are identified for two weeks.
Residents who test positive are placed into a COVID-19 positive cohort within the facility. The COVID-19 positive cohort is a dedicated, separate area (building, unit, or wing) within the facility to provide care for positive case residents. SNFs must have policies in place to ensure COVID-19-positive patients are cared for by dedicated health care workers in a separate area of the facility to minimize transmission risk and protect vulnerable populations.
Skilled Nursing Facilities Baseline Testing, July 22, 2020.xlsx