| Health care Personnel COVID-19 Training and Symptom Monitoring |
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Often unable to provide medical clearance and fit testing for N95 respirators
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Provided pay incentives to retain and reward staff while others supplemented health care providers through staffing agencies
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| Education, Monitoring, Screening, and Cohorting of Residents |
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Performed at least some symptom-screening activities for non-ill patients more often than minimum recommendation (eg, every shift rather than daily)
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Tracked oxygen saturation in addition to routine, recommended assessment for symptoms of COVID-19
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Unaware of or had not yet implemented additional symptoms added to CDC guidance in May 2020 (among facilities that performed screening and were assessed after guidance update)
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Had difficulty assessing residents with communication difficulties (eg, dementia, nonverbal)
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Reported that residents with dementia had difficulty using a cloth face covering or face mask for source control and staying in their room
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Described safety concerns about keeping doors closed for rooms of residents with fall risks
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Residents requiring feeding assistance eat in the dining room using social distancing, while other residents have meals in their rooms
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| Personal protective equipment supply |
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Implemented PPE optimization strategies but often did not understand when or how to safely implement these strategies
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Described using crisis capacity PPE strategies∗ in the absence of a shortage
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Locked-up PPE or limited accessibility due to concern for or evidence of theft
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Sought alternative approaches to usual suppliers to manage shortages, including recruiting volunteers to sew launderable gowns, purchasing supplies from local retailers, and reimbursing staff
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Substituted clothing items (eg, rain ponchos) for isolation gowns
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Described using excess PPE including shoe and hair covers
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Attempted to disinfect used N95 respirators, face masks, and isolation gowns by spraying with disinfectant or exposing to ultraviolet light prior to reuse
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| Core infection prevention and control practices |
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Reported difficulty obtaining ABHS and ABHS dispensers; multiple facilities reported receiving ABHS compounded by local distilleries; facilities would reuse and refill single use ABHS bottles and ABHS dispensers
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Staff unaware of contact time for EPA-registered disinfectants or provided inappropriate contact times for products
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