Infection Control in Senior Living Communities

Preventing the spread of COVID-19 and protecting residents is every senior living community’s highest priority right now. Senior living communities are home to the population most vulnerable to COVID-19 – older adults with underlying medical conditions. With new information rapidly coming out, many communities are adopting the most effective infection control methods as fast as possible. Many communities already have a communicable disease outbreak plan in place, but additional actions are necessary to overcome the pandemic.

Assessing the Community

In forming an effective response strategy, communities first comprehensively assess where the greatest potential for spreading infection might be. COVID-19 is most commonly introduced into communities through employees and visitors. Because of this, special attention is placed on particularly vulnerable areas of senior living communities:

• Entry points, heavily trafficked areas, common spaces and dining facilities.
• High-touch surfaces such as door handles, communal electronics, and furniture.
• Personnel schedules and assignments are under review so the community may begin taking the necessary steps to reduce outside contamination.

By understanding where a community is most vulnerable, leadership design the most effective responses. According to Dr. Kevin O’Neil, chief medical officer at Affinity Living Group, if the proper precautions are put in place, senior living communities are among the safest places for older adults.

“With assisted living’s focus on prevention, and resources and people who are experienced and dedicated to the care of this vulnerable population, people are likely more safe staying in their community. And until we know more about COVID-19, it’s better to stay in the assisted living environment.”

PPE

Wearing personal protective equipment (PPE) is among the most effective methods of controlling infection. Use of PPE is called source control, and it prevents spread of respiratory secretions when talking, sneezing, or coughing. Because COVID-19 is most commonly spread through respiratory droplets, diligent use of PPE can’t be overstated. All senior living community personnel are required to wear PPE at all times when they’re inside the community. It’s recommended that residents wear PPE any time they’re in contact with people outside of the community, and at all times if they leave the community for any reason. The different kinds of effective source control include:

• Facemasks
  • Also known as surgical masks, these are the most commonly used every-day masks recommended by the CDC. Facemasks protect against splashes, but in no way filter out air particles.
• Respirators
  • Respirators are face coverings that act in all the same ways as facemasks, with the added protection against airborne particles. Unlike facemasks, respirators are certified and regulated by the CDC. These are the preferred PPE recommendation for older adults, especially those with underlying health conditions such as heart disease and respiratory illnesses. The highest recommended respirator available to the public is the N95 filtering facepiece respirator.
• Cloth face coverings
  • Face coverings made of textile are not technically PPE and have a very specific use. They’re meant to keep the wearer from spreading respiratory secretions to others. Cloth coverings don’t necessarily protect the wearer from being infected by respiratory secretions or airborne pathogens and aren’t recommended for use by older adults or people with serious health conditions.

Disinfection Procedures

Defining the actual meaning of disinfecting is vital to examining best practices of disinfection for senior living communities. Disinfecting kills germs by using chemical disinfectants. Cleaning, on the other hand, removes dirt and impurities from surfaces. To most effectively reduce the risk of spreading infection, surfaces must first be cleaned and then disinfected.

COVID-19, known medically as SARS-CoV-2, is classified as an enveloped virus. Luckily, enveloped viruses are the least resistant to inactivation by disinfection. The structure of these viruses includes a lipid envelope, which is easily compromised by most disinfectants.

The Environmental Protection Agency (EPA) has created “List N,” which outlines effective disinfectants for use against COVID-19. This exhaustive list includes common household disinfecting cleaners, disinfecting wipes, and industrial-grade disinfectants for use by larger facilities. While many varieties of disinfectants are used by senior living communities, the naturally produced chemical hypochlorous joins the list of disinfectants being used in innovative ways.

Jonathan Barbieri with The Hearth senior living communities believes that one disinfecting solution in particular could revolutionize the senior care industry. It’s called Viking Pure PureSan solution. To Barbieri, it’s the “gold standard” of infection control.

Viking Pure is a two-step cleaning and disinfecting process that uses electrolysis to separate salt and water, creating an alkaline solution used for cleaning and an acidic solution used for disinfecting. The acidic solution is hypochlorous acid (HOCL) in a highly concentrated form, which is currently used by many hospitals as a high-grade disinfectant.

The solution is made onsite in an endless supply and thus provides cleaning solution that can be given to teams and community members, and sprayed safely each day on high-touch surfaces across the entire campus.

The Hearth has pioneered use of Viking Pure PureSan solution, implementing on-site production at each of its 15 communities. To date, Barbieri says The Hearth communities have produced around 13,000 gallons of PureSan solution. According to him, “On-site production properties of this solution have allowed us to produce hundreds of gallons of sanitizing solution at each campus to distribute to our teams, families, and to the local community. As you see stories of distilleries switching gears to help the public think of this resource as analogous to that effort. The good we can do by helping not just our own residents, teams, and families stay safe, but also the community at large, is truly an exciting opportunity.”

Each community cleans and disinfects the entire campus with the PureSan solution every day. In addition, they give every staff member their own bottle to use throughout the day. “We’ve started a whole movement,” Barbieri continues, “If you touch it, spray it.” Barbieri says that while the senior living industry is lifestyle-focused, communities are trying to help consumers understand that, “We’re also a health care option that is going to help improve your life and livelihood, and we’re prepared to provide the care you need today and tomorrow.”

Urgent Responses for Infection Control

While developing an infection control strategy plan can take some time, there are key actions communities can take to reduce the spread of COVID-19 infection.

• Ceasing all events
  • To help limit the spread of COVID-19, communities are cancelling on-campus events. Instead, they’re transitioning to hosting virtual events to stay connected with those interested in moving to senior living communities.
• Altering staff schedules
  • Training one or more staff members and assigning them to infection control is a key necessity during this time. The CDC has developed an online training course for this exact role. Communities often assign certain personnel to specific areas of the community.
• Minimizing visits
  • Communities prevent outside infection by significantly reducing, or completely eliminating, visits from residents’ loved ones for the time being. However, it’s important to support residents’ mental and emotional wellbeing as they can easily feel isolated during this time. Community team members encourage video conferences and other kinds of no-contact visitations, such as drive-by visits, as a safe way to ensure residents are protected both physically and mentally.
• Centralizing one entry point
  • To reduce the risk of external infection, only one entry point and one exit point is allowed. This makes it easier for a staff member to properly screen people coming into the community, as well as track who has been in and out of the community, in case an outbreak occurs.
• Sectioning off areas for potentially infected people
  • Quarantining infected residents is crucial to protect the rest of the community. Sections of a community are designated as quarantine areas and are completely blocked from outside contact, except of course for essential medical personnel.
• Replacing air filtration systems
  • Regularly cleaning a community’s air filtration system is a must for residents’ overall health, but now many communities are upgrading their filtration system to better capture particulates of pathogens in the air, reducing the spread of viral communicative diseases.
• Educating staff and residents on best practices
  • Knowledge is the first line of defense in protecting against COVID-19. Communities regularly update and remind staff and residents about COVID-19 information, including signs and symptoms, social distancing, hand hygiene and proper disinfecting procedures.
• Implementing strict social distancing rules
  • Transmission of coronavirus occurs much more commonly through respiratory droplets than through objects and surfaces. A minimum of six feet between people is currently recommended by the CDC to prevent spread. Senior living communities enforce strict social distancing rules as well as reconfigure dining rooms, libraries, and other common areas so that residents can easily maintain a 6-ft. distance no matter where they are in the community.

The Future of Infection Control in Senior Living Communities

As Jonathan Barbieri summarizes, “The importance of having an incredible barrier between the pathogens of today and tomorrow is going to set us apart as an industry.” Regardless of the size of the community or levels of care offered, every senior living community is hyper-focused on controlling the spread of COVID-19 and future viral threats.

Where You Live Matters is powered by the American Seniors Housing Association (ASHA), a respected voice in the senior housing industry. ASHA primarily focuses on legislative and regulatory advocacy, research, and educational opportunities and networking for senior living executives, so they can better understand the needs of older adults across the country.

SOURCES:
Where You Live Matters
CDC – Infection Control
Viking Pure Solutions at The Hearth
EPA List N
Senior Housing News