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The article discusses COVID-19 reporting requirements and infection control guidance for nursing homes and long-term care facilities. Here are the main points:

• QSO-20-29-NH, a memo issued on May 6, 2020, addresses COVID-19 reporting requirements to the National Healthcare Safety Network (NHSN), as well as to residents, their representatives, and their families.
• The CDC's COVID-19 Infection Control Guidance page provides detailed guidance on various topics, including personal protective equipment, testing, cohorting, and transmission-based precautions.
• The article mentions additional action steps for improving air quality in facilities, such as purchasing portable air cleaners with high-efficiency particulate air filters through CMS's civil money penalty reinvestment program.
• The White House's Winter Playbook for Nursing Homes and Other Long-term Care Facilities to Manage COVID-19 and Protect Residents, Staff, and Visitors is also referenced.

Overall, the article aims to provide guidance and resources for senior care facilities to manage COVID-19 and protect their residents, staff, and visitors.

This article was originally found on iadvanceseniorcare.com

CMS recently published an Interim Final Rule that would effectively transition the entire industry to PCR testing exclusively. The basis for this decision is that antigen tests do not detect an "active infection", and therefor cannot accurately detect the coronavirus. Here's the excerpt taken from CMS's publication:

"A diagnostic test shows if a patient has an active coronavirus infection. As of the date of this guidance, there are two types of diagnostic tests which detect the active virus – molecular tests, such as RT-PCR tests, that detect the virus’s genetic material, and antigen tests that detect specific proteins on the surface of the virus. An antibody test looks for antibodies that are made by the immune system in response to a threat, such as a specific virus. An antibody test does not identify an active coronavirus infection; therefore, conducting an antibody test on a staff or resident would not meet the requirements under this regulation."

‍https://www.cms.gov/files/document/qso-20-38-nh-revised.pdf

In working with EasyReporting customers, we've come to realize that not everyone fully understands the values the NHSN is requiring in the Daily Entry. We published a more comprehensive post about all the current fields that are required, but felt it would be more meaningful to discuss the specific fields that are most commonly misunderstood.

Before we dive into the specific fields that can be problematic, lets first address a global problem over the entire dataset. Rolling counts have been an issue since the NHSN first started tracking COVID-19 data in 2020. This issue occurs when a facility manager counts a positive resident in one reporting window, and it accidentally rolls to the next reporting window as well. It's easy to understand how a mistake like this could occur. Before using EasyReporting, many of our customers track COVID data in a spreadsheet. When all the data has been identified, it's hard to remember which residents were counted in which numbers. EasyReporting solves this problem in two ways:

• Reporting Window The NHSN has been vocal about requesting providers submit data on a daily basis. That's what it is called the "Daily Entry". The bare minimum is once a week; and that is what the CMP (fines) can be issued for. Having said that, many of our customers submit twice a week (or three times in some cases). This makes avoiding "rolling counts" much more difficult given the reporting windows are changing. EasyReporting manages reporting windows flawlessly. We know when a reporting window begins and ends; down to the millisecond. This allows to calculate the NHSN dataset with a high level of precision.
• Rolling Counts When EasyReporting puts a "3" in your COVID positive dataset we know exactly who those three residents (or staff) are. We have unique identifiers for every person we track. Of course none of the identifiable information shows on the NHSN's report, but if ever audited we can prove how we calculated each number.

Also worth noting, the most significant update the NHSN made to the dataset was the update on November 23rd, 2020. We'll refer to this in shorthand by "11/2020". That's the update where flu and respiratory disorders were included in the required dataset.

numrespostest

numrespostest is the number of positive COVID-19 tests within the reporting window. This change was a big shift away from the old metric numresconfc19. This was part of the 11/2020 update. It was significant statement that providers were no longer responsible for determining if a resident had a confirmed case of COVID-19; instead the NHSN put the focus directly on testing. This trend has continue to evolve as the NHSN's relationship becomes more direct with testing devices/parties.

numresdied & numresc19died

numresdied is the number of deceased residents within the reporting window, and numresc19died is the number of those residents with a positive COVID-19 diagnosis. This is not a cause of death conclusion, it's simply an observatory metric.

Why is this metric on the misunderstood list? Look at the NHSN's definition: "Of the number of reported Total Deaths, report the number of residents with COVID-19 who died in the facility or another location." It is really difficult for providers to track residents once they are transferred out of their facility. It takes discipline to track down outcomes outside your facility, log them in your EHR, and report them to the NHSN. This is why a tool like EasyReporting is so helpful in reporting accurate data.

numressuspc19

This is the "suspected residents" metric. This metric is no longer part of the required dataset. I'm curious if it is because this metric is so subjective, leading to inaccuracy. There is really no concrete way to prove a resident is suspected of having COVID. Maybe this metric was more meaningful when providers were forced to used outsourced lab results that would take 5-7 days to return. Despite this metric no longer being in the submitted NHSN dataset, EasyReporting still calculates it. We use the residents previous health history, facility outbreak data, and proximity to calculate how likely it is a resident has COVID-19.

numressuspc19

This is the "suspected residents" metric. This metric is no longer part of the required dataset. I'm curious if it is because this metric is so subjective, leading to inaccuracy. There is really no concrete way to prove a resident is suspected of having COVID. Maybe this metric was more meaningful when providers were forced to used outsourced lab results that would take 5-7 days to return. Despite this metric no longer being in the submitted NHSN dataset, EasyReporting still calculates it. We use the residents previous health history, facility outbreak data, and proximity to calculate how likely it is a resident has COVID-19.

numrespostestposag

"Of the number of reported residents above with a Positive Test, how many were tested using positive SARS-CoV-2 antigen test only (no other testing performed)".

Although there are some exciting developments around PCR-based POC devices, most (if not all) POC devices in facilities are antigen-based. This metric can be tricky because you have to ensure that the resident doesn't have any other test sources, like a PCR-based outsourced lab result. This typically isn't the case because providers stop testing as soon as a positive diagnosis is discovered, but some providers will PCR test a positive resident to see if it is a false-negative. In the event this resident has a mix of testing, they should not be counted towards this metric. This is some pretty tricky logic for a human to keep track of calculate, that's why we leave the heavy lifting to the logic in EasyReporting.

numResPosTestPosAgNegNAAT

"Of the number of reported residents above with a Positive Test, how many were tested using positive SARS-CoV-2 antigen test and negative SARS CoV-2 NAAT (PCR)".

Another difficult metric to calculate. If you only have twenty residents in your facility this might be something you can keep track of, but when you start hitting 110-120 residents, it makes it really difficult to calculate this metric. Especially if you have outsourced lab results in the mix and you are reporting twice a week.

c19nonpoctestresults

"During the past two weeks, on average, how long did it take your LTCF to receive SARS-CoV-2 (COVID-19) viral test results of staff and/or facility personnel?".

Notice that this metric is not mapped to the reporting window; the time window to calculate this metric is the last 14 days. At EasyReporting, we focus on accuracy. This is the one metric that is not linked to the reporting window in any way. Instead we calculate the exact latency on your outsourced/PCR lab results, from the time the sample is received to the time the test results are published.

Point of Care (POC) Test Reporting Tool:

The following enhancements will be made.

1. Analysis updates:
   • A line list will be available for POC test results for Visitors.
   • First name, middle name, and/or last name will be available in the list of variables for inclusion in the line lists of Staff, Resident or Visitor POC results. This option is being created to fill a need identified by facilities for use during visits with their state health department.
2. The ability to confer Group rights for POC data will be enabled. Rights to POC data will be automatically conferred to state health departments.
3. Facilities and state health departments will be able to upload POC test results by use of the NHSN Direct protocol in a Health Level-7 (HL7) format. For information on how to enroll and use the NHSN Direct process, please see the guidance provided at https://www.cdc.gov/nhsn/cdaportal/importingdata.html#DIRECTProtocol . Note that a small fee is associated with using Rosetta Health, the Health Information Service Provider (HISP) enabled to use the DIRECT protocol. Send any questions to our Direct team at NHSNCDA@CDC.GOV with the subject line ‘Direct Submissions for POC data’, and someone will help with the onboarding process. Please note, that whenever data is uploaded to NHSN, it will be necessary to monitor the success of the upload and to address any error codes in a timely manner. This is especially true with the NHSN Point of Care Test Result Reporting Tool, as the data is in turn transmitted to the Association of Public Health Laboratories every 15 minutes and from there to state health departments. Failure to correct data in a timely manner may result in incorrect data being communicated and used for public health prevention and control activities.

Resident Impact and Facility Capacity Pathway:

Vaccination Status section: Additional COVID-19 vaccine added- Janssen (Johnson & Johnson). Unspecified status added to permit for counts of residents who received full vaccine series (based on vaccine manufacturer recommendations) from unspecified manufacturer.

‍Supplies and Personal Protective Equipment (PPE) Pathway: The Supplies and Personal Protective Equipment pathway has been updated to include the optimization strategies that LTCF’s are using regarding their PPE supply items. The requirement to report once a week is still in place for this pathway. Reporting for the updated data elements to begin the week of March 8, 2021.

1. Alcohol-based hand rub will now appear on the form as opposed to alcohol-based hand sanitizer. This wording change is to include a broader range of products and to align with CDC guidelines. Availability as well as urgent need are the areas to report for this product.
2. PPE supply items will now include the type of optimization strategy the facility is using as a reporting measure. The supply items have not changed and continue to include N95 respirators, facemasks, eye protection, gowns, and gloves. The availability for these items will be reported by indicating the optimization strategy that is being used for each supply item. The optimization strategies include conventional, contingency, and crisis capacity strategies. Users will also be asked to report if there is an urgent need for each PPE supply item listed above.
3. A new section added called, Need for Government Support or Assistance. This new section offers facilities a new option to indicate they would like outreach from state or local government to discuss COVID-19 assistance needs related to staffing shortages, personal protective equipment shortages, SARS-CoV-2 (COVID-19) testing supply shortages, infection control/ outbreak management, staff training, and COVID-19 vaccination for residents and/or staff. Local, State, and Federal governments will use affirmative (“Yes”) responses to this question as another way to monitor assistance needs that facilities face and to prioritize outreach and response actions.

Importantly, these new questions do not replace established local and state mechanisms to request assistance, particularly in cases where those needs present immediate threats to the health and safety of residents or staff. They also do not guarantee resources can be provided as local, state, and federal resources are allocated based on supply and priority of need. Nonetheless, the questions do offer facilities a new option to proactively request outreach from local or state government partners (for example, public health departments and emergency management agencies) to discuss assistance needs.

‍Therapeutics Pathway:

1. Additional therapeutic added- Bamlanivimab and etesevimab (Lilly).

‍NEW Data Quality Alerts:

1. Users will see Data Quality Alerts that impact NHSN COVID-19 data reported to CMS. These actionable alerts will allow users to review and verify accuracy of the data within the NHSN application and make corrections if needed.

‍Analysis:

1. COVID-19 Dashboard: The NHSN COVID-19 dashboards for facility and group have been updated to reflect recent changes to the variables in the Resident Impact and Facility Capacity pathway.
2. Line Listings: Users will see new and updated line lists for the surveillance data reporting pathways. Be sure to GENERATE DATA SETS prior to running analysis reports.

‍Weekly NHSN COVID-19 Vaccination Data Modules:

1. The COVID-19 Vaccination Module will now include updated questions about vaccine supply in the summary forms for Healthcare Personnel and Residents (Questions 4.1 through 4.4).
2. Instructions for .CSV upload have been posted on the NHSN website and are located under Supporting Materials: https://www.cdc.gov/nhsn/ltc/weekly-covid-vac/index.html  
3. Updated instructions on how to generate line lists and bar charts have been posted on the NHSN website and are located under Supporting Materials: https://www.cdc.gov/nhsn/ltc/weekly-covid-vac/index.html
4. When entering COVID-19 weekly data, click on the save button located at the bottom of the screen to save data. It is imperative to save data for each module tab before continuing to another tab.