Long-Term Care Facility Resources

Symptoms: 

Acute respiratory illness (ARI) is an illness characterized by any two of the following signs and symptoms that are new or worsening from the resident's normal state:

• Fever (temperature two degrees above a resident’s established baseline)
• Cough (productive or nonproductive)
• Runny nose or nasal congestion
• Sore throat
• Muscle aches
• Shortness of breath or difficulty breathing
• Low oxygen saturation in the blood (normal levels are between 95 and 100%, but may vary for people with certain medical conditions)

Reporting: 

Case definition: Three or more residents/staff from the same unit/wing with two or more acute respiratory symptoms within 72 hours of each is reportable to the Local Health Department (Fond du Lac County).

Common acute respiratory viruses:

• Coronavirus
• Influenza (A and B)
• Parainfluenza
• Respiratory Syncytial Virus (RSV)
• Adenovirus and Human Metapneumovirus (HMPV)

Many viruses other than SARS-2 (COVID) can cause severe respiratory illness and outbreaks especially in a congregate setting. Testing only for SARS-2 and Influenza will not assure an accurate identification of the etiology of the illnesses, HIGHLY suggest full respiratory panel for testing.

Steps to report

1. Fill out appropriate line list template
2. Email the line list to annie.charneski@fdlco.wi.gov or fax to 920-929-3102
3. Review Wisconsin DHS guidelines
4. Follow your organizations outbreak management plan
5. Implement droplet precautions
6. IF Influenza review
   1. CDC Prevention strategies for seasonal influenza in Healthcare settings
   2. CDC interim guidance for Influenza Outbreak management in Long-Term Care facilities and Post-Acute care facilities
7. IF COVID review CDC interim guidance for managing Healthcare personnel with SARS-CoV-2 Infection or Exposure to SARS-CoV-2. 

For local health departments outbreaks can be closed after two incubation periods have passed with no new cases being identified. For COVID-19 outbreaks, this is 28 days and for all other ARI outbreaks, it is approximately 14 days.

Acute gastrointestinal illness symptoms:

• Nausea
• Vomiting
• Diarrhea (could be blood tinged)
• Abdominal cramping
• Fever greater than 100F or 2 degrees above baseline
• Chills

Reporting: 

Case definition: three or more residents or staff experience vomiting and/or diarrhea within a 72-hour period and have geographic commonality (i.e., same wing, unit, floor). Based on symptomology, not on clinical diagnoses. This is reportable to the local health department (Fond du Lac County).

Common viral GI Pathogens:

• Norovirus
• Rotavirus
• Sapovirus

Stool testing may be available through the Wisconsin state lab of hygiene. Reach out to your local health department to see if your facility would qualify for fee-exempt stool testing. Please note, this is to confirm etiology out outbreak, not to confirm each case.

Steps to report

1. Fill out appropriate line list template
2. Email the line list to annie.charneski@fdlco.wi.gov or fax to 920-929-3102
3. Review Wisconsin DHS Guidelines “Recommendations for Prevention and Control of Acute Gastroenteritis Outbreak in Long-Term Care facilities”
4. Follow your organizations outbreak management plan
5. Implement standard precautions

Acute gastrointestinal outbreaks can be closed after 10 days have passed with no new cases being identified.

This guidance applies to common and seasonal respiratory viruses that circulate in Wisconsin each year such as influenza, respiratory syncytial virus (RSV), parainfluenza, rhinovirus/enterovirus, and SARS-CoV-2. 

Wisconsin Department of Health Services (DHS) guidelines:

A memo from WI DHS provides guidance to prevent health care-associated transmission of respiratory viral infections by defining when health care personnel should be excluded from work and when they may safely return. 

View the memo here. 

Centers For Disease Control and Prevention (CDC) guidelines: 

View CDC's return to work guidelines for healthcare providers who have tested positive or were exposed to COVID here. 

Wisconsin Department of Health Services:

Display Signs/Fact Sheets:

• Norovirus Factsheet
• Handwashing Factsheet
• Attention All Visitors Sign
• No Hand Sanitizer Sign
• Cover Your Cough Sign
• Proven and Preferred Method to Kill Norovirus

Resources:

• Preventing and Controlling Respiratory Illness Outbreaks in Long-Term Care Facilities
• Recommendations for Prevention and Control of Acute Gastroenteritis Outbreaks in Wisconsin Long-Term Care Facilities 
• COVID-19, flu, and RSV activity level and trajectory data 
• Infection prevention and control resources for health care professionals 

CDC:

• Core Infection Prevention and Control Practices for Safe Healthcare Delivery in All Settings
• Infection Control Guidance: SARS-CoV-2
• Interim Guidance for Managing Healthcare Personnel with SARS-CoV-2 Infection or Exposure
• Interim Guidance for Influenza Outbreak Management in Long-Term Care and Post-Acute Care Facilities
• Testing and Management Considerations for Nursing Home Residents with Acute Respiratory Illness Symptoms when SARS-CoV-2 and Influenza Viruses are Co-circulating 
• Viral Respiratory Pathogens Toolkit for Nursing Homes

Other:

Environmental Protection Agency (EPA) approved products to kill norovirus