Patient and Staff Safety During COVID-19: Waiting and Break Room Tips

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As healthcare facilities are reopening, Infection Control Consulting Services is receiving questions from clients concerning recommended practices for waiting rooms and break rooms. Here we provide guidance for both areas.

8 Waiting Room Infection Prevention Tips

In the early stages of reopening, facilities were asking visitors to wait in their cars in facility parking areas as patients underwent procedures and receive treatment. Now that summer has arrived, facilities are concerned about asking visitors to wait in cars that will become hot and potentially unsafe.

If you are located in an area whereby visitors cannot go home and wait for your call after care is completed or are unable to go to an indoor place such as a coffee shop, mall, or restaurant, you may have no choice but to allow visitors in your waiting rooms.

Consider implementing the following in your waiting room:

1. No children allowed.

2. Only one visitor per patient. However, if there are extenuating circumstances, these tips are suggestions, not mandates. You will ultimately need to decide how many visitors to allow under such circumstances.

3. Patient is required to wear a face covering (preferably a medical mask, and if you have enough, you could provide one). Nobody is permitted to enter the facility without faces covered. If you will be providing the visitor with a mask, the patient should receive the mask from you and take it outside to the visitor before the visitor is permitted to enter.

4. When screening patients for symptoms and temperature, consider asking the visitor if he/she is feeling ill. You may want to do a quick thermal scan of the visitor to check for a temperature. You do not want anyone sitting in your facility who is not well. You may want to mention to the patient during the telephone screening that their accompanying visitor will be waiting in the facility, and will not be permitted if they are not feeling well. Also mention that if the visitor is staying, they need to wear a face covering before entering and for the duration of their visit.

5. Spatial separation including chair placement should include grouping two chairs together: one for patient waiting to be taken back, if you are not taking them back immediately upon arrival, and one for the visitor. If you are not having patients sit in the waiting room, single chairs are acceptable as long as they are at least 6 feet apart. For facilities with large waiting rooms, it is best to space chairs out further than 6 feet apart, if possible. Removing chairs from the waiting room to make space for separating chairs may be necessary.

6. Place alcohol hand sanitizer dispensers in the waiting room. The number of dispensers should depend upon how many people can be accommodated. As part of proper respiratory hygiene prior to COVID-19, you should have made tissues and trash cans available in the waiting room. However, people who are visibly ill, especially with runny noses or sneezing, should not be in the waiting room even if they are wearing a mask.

Surveyors will look for the tissues and trash cans. If you are concerned that tissues will be "stolen," you may need to keep them at the receptionist's desk and post notices in your waiting area about the availability of tissues at the desk.

7. Remove all reading material.

8. Assign staff to sanitize the room, particularly chairs, doorknobs, and other high-touch surfaces, and increase the amount of times they perform sanitizing. Each facility is different and will need to determine a feasible and appropriate rotation for disinfection.

6 Break Room Infection Prevention Tips

1. Depending on the size of your break room, you may want to stagger breaks and assign times to staff to take breaks, if possible, taking into consideration their assignment schedules. If your break room is very small, permit only one person in at a time.

2. In larger break rooms, keeping people 6 feet away from each other at a minimum and limiting the number of employees in the room at one time is advisable. Block off seats or remove chairs to encourage such practices.

3. Advise employees to do their best to socially distance themselves when masks are off for eating and drinking.

4. Encourage staff to keep their masks on until they are sitting down and ready to eat. Heating up food, going to the refrigerator, and moving around the break room for other various reasons before sitting down is best performed while wearing a mask. Staff should be advised to remove their masks as little as possible and for as short amount a time as possible.

5. Ask each employee to wipe down the space they came into contact with while in the break room, including the table and chair, upon completing their break. Provide wipes for this purpose.

6. If possible, keep the break room door open to allow for circulation of air, if safe to do so. Some facilities have their break room within visual range of patients or located in other areas that may not be desirable for an open door. The virus will not be pushed out of the room as the break room is not under positive pressure but allowing air in to circulate is a good idea.

Joint Commission Resuming Survey and Review Activities: Key Takeaways

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The Joint Commission recently announced it was resuming some survey and review activities beginning this month. Here are key takeaways:

  • Surveyors will work to conduct a thorough assessment that seeks to understand how organizations adapted to the health crisis and will review current practices to assure the provision of safe care in a safe environment.

  • Surveys will not retroactively review compliance.

  • An organization's emergency operations plan will not be the focus of this survey activity.

  • Low-risk organizations where surveyors can go in safely will be prioritized.

  • Organizations will be expected to provide masks and/or other personal protective equipment (PPE) to surveyors and reviewers during on-site visits.

  • Technology will be used to reduce the number of people required to sit next to one another for an extended time (e.g., conducting electronic medical record reviews using screensharing or projecting the record, simulating an activity if surveyors are unable to access a high-risk space, interviewing patients/staff by phone).

  • Organizations can ask to use audio and/or video conferencing if they want to expand their number of attendees participating in the process.

The Joint Commission is holding regular webinars to share updates on its survey and review activity plans. At least one or more members of the Infection Control Consulting Services (ICCS) team participants in these programs. Any significant updates issued by The Joint Commission and other accreditation agencies will be shared via the ICCS LinkedIn page. ICCS encourages facilities to reach out to their account executive to discuss survey schedules and upcoming visits, if applicable.

CMS Increases Infection Control Noncompliance Penalties for Nursing Homes

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The Centers for Medicare & Medicaid Services has announced it is increasing the civil penalties for nursing homes that fail to comply with infection control requirements.

The federal agency stated it was enhancing enforcement for facilities with persistent infection control violations and imposing enforcement actions on lower level infection control deficiencies to help ensure they are addressed with greater urgency.

CMS also announced it has implemented a new COVID-19 reporting requirement for nursing homes. Furthermore, the agency is partnering with CDC's federal disease surveillance system to quickly identify problem areas and inform future infection control actions.

The announcement from CMS included several other developments, including the tying of some Coronavirus Aid, Relief and Economic Security (CARES) Act funding to state completion of focused infection control nursing home surveys, requiring states to implement revised and expanded survey activities, and refocusing the approach of quality improvement organizations (QIO) to assist in combating COVID-19 within nursing homes.

These changes took effect when they were issued on June 1.

The announcement from CMS comes following the release of U.S. government data showing that nearly 26,000 nursing home residents have died from COVID-19 and more than 60,000 have fallen ill.