TABLE 1.

Implementation of Infection Prevention and Control Policies and Procedures at a Pediatric Long-Term Care Facility

Date	Policy	Description
January 2009	Visitor ARI screening prior to facility entry	• Visitors with ARI symptoms are restricted from entering. Security guard administers symptom-based screening questionnaire to all visitors and informs IP&C coordinator or nurse manager if symptoms are reported or observed. • Visitors <13 years are restricted from facility’s units October through May.
October 2010	Enhanced staff ARI screening	• Nurse managers monitor staff and refer to facility’s employee health service if ARI symptoms are present. • Nursing office monitors daily staff absenteeism logs and refers reported ARI symptoms to IP&C coordinator for follow-up.
October 2010	Viral respiratory illness algorithm	• Symptom-based surveillance identifies residents with ARIs, and prompt testing for respiratory viral pathogens is performed. IP&C coordinator reviews daily reports of resident ARI symptoms (fever/change from baseline temperature, vomiting, new/increased secretions, increased oxygen requirement, cough) and performs daily rounds to review possible ARI cases with nurse managers. • Diagnostic testing is performed by referral laboratory if symptoms persist >48 h.a DFA is performed. If DFA is negative, viral culture is performed. If both tests are negative, RT-PCR is performed. DFA and PCR results are available within 48 h and culture results are available within 7 d.
March 2012	Facility relocation	• Increase in facility size from 90,000 to 165,000 square feet. Only 1 bed added (136 to 137 beds). No. of 4-bed rooms decreased from 34 to 12, allowing more space between residents.
March 2013	Mandatory staff influenza vaccination	• All staff are required to receive annual influenza vaccination. Staff with contraindications or documented religious exemptions are required to wear masks for the duration of the influenza season, defined annually by the New York State Department of Health. Unvaccinated staff without exemptions are suspended until vaccine is received.

NOTE. ARI, acute respiratory infections; IP&C, infection prevention and control; DFA, direct fluorescent antibody; RT-PCR, reverse transcriptase polymerase chain reaction.

^aDFA tests for adenovirus; RSV; parainfluenza 1, 2, 3; influenza A and B; and metapneumovirus. Viral culture tests for adenovirus; RSV; parainfluenza 1, 2, 3; and influenza A and B. RT-PCR tests for adenovirus; coronavirus HKU1, NL63, 229E, OC43; human metapneumovirus; human enterovirus/rhinovirus; influenza A; influenza A/H1; influenza A/H3; influenza A/H1 − 2009; influenza B; parainfluenza viruses 1, 2, 3, 4; respiratory syncytial virus; Bordetella pertussis; Mycoplasma pneumoniae; and Chlamydophila pneumonia.