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Long-Term Care Homes

COVID-19 Testing for Long-Term Care Home Staff

Memo

July 16, 2020

Memorandum to: Long-Term Care Home Licensees

Subject: COVID-19 Testing for Long-Term Care Home Staff

Ontarians are helping reduce the spread of COVID-19 by staying home, practising social distancing and proper hand hygiene, cleaning with disinfectants, and wearing masks or face coverings. We must continue to do everything we can to protect residents, staff and their families in all long-term care homes.

Testing is key to defeating COVID-19, as the sooner we can identify cases, the better positioned we are to contain them and save lives. Ontario has taken aggressive action to testing to understand the status of COVID-19 and inform infection prevention and control measures.

Further to our memo of May 31, 2020, surveillance testing of long-term care staff will continue until further notice. Long-term care homes should continue to ensure that all staff receive at least two COVID-19 tests per month.

The testing includes all individuals working in long-term care homes, including frontline workers, management, food-service workers and contracted service providers. Testing is to be conducted by the long-term care home, where possible. If on-site testing is not feasible, homes are asked to work with their established regional contacts at Ontario Health to identify alternative approaches.

Continued testing is vital as the economy continues to reopen. We must keep doing the things that are working — including tracking the rates of infection and/or transmission in the community through testing and surveillance.

By continuing to work together, including getting tested, we will stop the spread of this virus, safe lives, protect staff and their families, and help residents reunite with their loved ones faster.

Thank you for your continued dedication and commitment to improving the quality of long-term care in Ontario.

For additional information and frequently asked questions, please refer to the enclosed document or email your regional contact at Ontario Health.

Sincerely,

Originally signed by:

Richard Steele
Deputy Minister, Ministry of Long-Term Care

Matthew Anderson
President & CEO, Ontario Health

cc:
Ms. Janet Hope, Assistant Deputy Minister, Long-Term Care Policy Division
Mr. Brian Pollard, Assistant Deputy Ministry, Long-Term Care Operations Division
Ms. Donna Duncan, Ontario Long Term Care Association
Ms. Lisa Levin, AdvantAge Ontario
Mr. Dan Kaniuk, Chair, Board of Directors, Ontario Long-Term Care Association
Ms. Jane Sinclair, Chair, Board of Directors, Advantage Ontario
Ms. Catherine Brown, President, Shared Services, Ontario Health
Dr. Dirk Huyer, Chief Coroner for Ontario
Ms. Olha Dobush, Executive Lead, LTC Stabilization

 


 

Frequently Asked Questions

COVID-19 Surveillance Testing - Frequently Asked Questions Regarding Long-Term Care (LTC) Homes Staff Testing

July 16, 2020

Requirements for Tests

Do all staff need to be tested?

Yes, all staff should be tested. The health and safety of workers is a top concern during the COVID-19 (coronavirus) outbreak. This includes protecting them from exposure to infectious diseases at work. To provide a safe environment for both staff and residents, all staff need to be tested.

The testing includes all individuals working in long-term care homes, including front-line workers, management, food-service workers and contracted service providers.

How often do staff need to be tested?

Staff need to be tested at least twice a month until further notice.

If staff haven't been tested in July yet, is testing twice between now and end of July still required?

Rounds of testing should be about two weeks apart; if staff haven't yet been tested in July, at least one round of testing between now and end of the month is appropriate.

Do staff need to be tested when they return to work after an absence?

Yes, all staff members should be tested to ensure the safety of both colleagues and residents.

Do staff need to provide consent every time they are tested?

Every person obtaining a test provides consent — this includes staff members. A new consent form can be used for each round of testing or a single form can be used to indicate multiple rounds of testing. Any positive test results for any person, including staff, will be sent to the local Public Health Unit for case management (e.g., contact tracing, etc.). Local Public Health Units will notify the LTC home of any positive results.

To obtain all results (positive and negative) from the ordering clinician, LTC homes require the individual staff person's consent.

What happens if staff refuse to be tested?

The health and safety of workers is a top concern during the COVID-19 (coronavirus) outbreak. Testing results help employers protect both staff and residents from exposure to infectious diseases while on the job. Homes should follow their policies and procedures to protect health and safety of their staff and residents, including those related to staff refusal.

If staff have already been tested and the result was negative for COVID-19, do they need to be retested? Why?

Yes, they do. Ongoing testing of all staff in LTC homes will help ensure the safety of both staff and residents.

Testing is done at a point in time. Existing literature indicates that the incubation period (the time from exposure to development of symptoms) of COVID-19 ranges from 2-14 days.

Retesting is necessary because the virus may not be detectable when the person was originally tested. In addition, the person may have come into contact with another person (who was symptomatic or asymptomatic) to the virus in the time after the earlier test.

Do on-site contractors who provide scheduled contracted services to the homes (e.g., hair-dressing) need to be tested?

Yes, on-site service providers working in the long-term care homes (e.g., hair-dressing) should also be tested. For these service providers, this testing can occur at an Assessment Centre and they are required to verbally attest to home staff that they have tested negative for COVID-19 within the previous two weeks and not subsequently tested positive.

Testing Process and Availability of Test Kits/Swabs

How will this testing be coordinated?

LTC homes are asked to conduct on-site staff testing, where possible. If on-site testing is not feasible, homes may connect with their regional contacts at Ontario Health for support, or staff may be tested at a local Assessment Centre. Staff going to an Assessment Centre for testing must be provided with the assigned home-specific investigation (INV) number for use by the Assessment Centre.

LTC homes are asked to connect with their Ontario Health regional contact(s) at the appropriate email address below, if they have additional questions.

Where can LTC homes get swab testing kits for on-site testing?

LTC homes may be able to obtain swab testing kits from their local/regional distribution source. If not, the kits can be obtained directly from Public Health Ontario using an online request form. Please note that swabs should be ordered 72 hours in advance, to ensure timely delivery.

Going forward, will LTC homes automatically receive swabs on a bi-weekly basis or will they need to request swabs for each round of testing?

LTC homes are requested to test staff at least twice a month, and they will need to acquire the necessary swabs for each round of testing from their local/regional distribution source (or from Public Health Ontario using an online request form). The testing will continue until further notice.

How can the LTC home help prepare their staff for testing?

The home should communicate to staff that, should they have a positive test result, they must self-isolate as soon as they learn of the result and they will receive further direction from Public Health.

Conducting the Test

Who can perform the test?

The test can be performed by a physician, nurse practitioner, registered nurse or registered practical nurse. In addition, paramedics, physician assistants or other allied health professionals can perform the test.

What other human resources are available for conducting testing (e.g., mobile teams) considering LTC homes may have limited capacity to take on the significant time required to test all staff?

LTC homes are asked to work towards an independent approach to staff testing. If on-site testing is not feasible, local Assessment Centres can be used, and staff are to be provided with their assigned home-specific investigation number (INV) for use by the Assessment Centre.

Can a LTC home determine their own testing dates, or will these dates be assigned from Ontario Health?

Testing dates can be determined by LTC homes, but rounds of testing should be about two weeks apart. Ontario Health or the Region may request information about each LTC home's planned testing dates and volumes in order to manage laboratory resources.

What types of swabs are available and when should they be used (e.g., nasopharyngeal, nasal only, throat and nasal)? Is it possible to do throat swabs if staff resist nasal swabs?

The nasopharyngeal (NP) swab is recommended as the best choice for COVID-19 testing and provides the most accurate results. Other options can be used, which may be less sensitive and slightly less invasive, including deep nasal swabs, anterior nasal swabs and throat swabs. More information can be found on Public Health Ontario's test information sheet. The choice of test should be a clinical decision made by the health care provider.

Please note, swabs distributed by Public Health Ontario are dependent on what they have available at the time; they cannot guarantee that requesters will be able to receive their preferred swab type.

How do we get personal protective equipment (PPE) to protect those doing the swabbing?

Homes will use their own supply of PPE for testing purposes. Homes can connect with their Ontario Health regional contacts with any questions about PPE requirements and sourcing.

For LTC homes in active outbreak, how and when will residents and staff receive testing?

Public Health Units will continue to coordinate on-site testing of residents and staff of LTC homes in active outbreak. The LTC home will work collaboratively with the Public Health Unit to ensure testing of all residents and staff is completed. This will happen as soon as possible after an outbreak has been declared.

Requisition

Where can LTC homes get the lab requisition for staff testing?

The lab requisition form is available here. Each home should obtain their unique investigation (INV) number for staff testing from their established regional contact at Ontario Health. The home can re-use this number for each round of COVID-19 staff testing. The unique INV number must be entered onto the requisition form.

Who should be identified as the ordering clinician on the requisition?

For on-site testing, each LTC home should determine their appropriate ordering clinician. This could be, for example, a contracted occupational health physician, or a physician or nurse practitioner from an external medical team. If the LTC home cannot identify an appropriate ordering clinician for on-site testing, staff should be sent to an Assessment Centre for testing. Staff going to an Assessment Centre for testing must be provided with the assigned home-specific investigation (INV) number for use by the Assessment Centre.

How will surveillance numbers (i.e., investigation (INV) numbers) be assigned for each home?

A unique investigation number (INV) for each facility will be provided by your established regional contact at Ontario Health:

This number can be re-used for each round of COVID-19 staff surveillance testing at the facility (indefinitely).

Does the approach for testing LTC home staff change if there is an outbreak in the home?

Yes, Public Health Units will support testing in cases of an outbreak and in these cases the outbreak number will be used in the requisitions.

Labs

For information on the routing and transportation of specimens from LTC facilities to the Provincial Diagnostic Laboratory Network.

Results

How are positive test results conveyed and managed (e.g., contact tracing)?

The clinician(s) listed on the requisition form will receive the results directly and will notify the person of their positive result. The local Public Health Unit will contact the person to conduct case management (e.g., contact tracing) and will notify the LTC home of the staff with positive results. Staff can also access their results (positive and negative) through the COVID-19 Test Results Website, if they include their (green) health card number on the requisition.

To support timely follow-up, people should include their primary care physician's contact information on the requisition.

How can the ordering clinician ensure reports are received as soon as results are available?

The ordering clinician can receive test results through auto-faxing and view results in online electronic health record viewing solutions (e.g., provincial viewers or Ontario Laboratories Information System-enabled electronic medical records).
Before submitting specimens, clinicians interested in auto-faxing should contact the testing lab to complete a fax verification process (e.g., lab faxes a new submitter and the submitter faxes back to verify the fax came to the correct number and location). The clinician should also ensure their fax machines are turned on at all times and are able to receive the expected volume of lab reports (e.g., memory capacity, toner, paper). Results that cannot be faxed will be mailed to an address provided on the requisition.

If the clinician's organization currently does not have access to an online viewing solution, they may complete the online form to submit a request.

How can LTC homes get the results of their staff's tests (all results, not just positives)? Should a consent form be used?

Local Public Health Units will notify the LTC home of any positive results. To obtain all results (positive and negative), LTC homes must develop a process for staff to provide consent to have this information released to the home by the ordering clinician or for staff to share their results directly.

Do LTC homes need to collect and track any statistical information on the number of staff swabs collected and the results?

Where possible, LTC homes are asked to keep statistical information about the number of staff tested and the dates on which testing was conducted.

In managing testing information, homes must continue to adhere to the requirements of the Freedom of Information and Protection of Privacy Act and the Personal Health Information Protection Act.

Do LTC homes need to report this information?

Homes are not required to report the available information proactively. Statistical information, however, may be requested by the Ministry of Long-Term Care, the Public Health Unit for the area in which the LTC home is located and Ontario Health.

In managing testing information, homes must continue to adhere to the requirements of the Freedom of Information and Protection of Privacy Act and the Personal Health Information Protection Act.

Are there any other reporting requirements related to positive test results?

If an employer is advised that a worker has tested positive for COVID-19 due to exposure at the workplace, or that a claim has been filed with the Workplace Safety and Insurance Board (WSIB), the employer is required to give notice in writing within four days to:

Additionally, the employer must report any instances of occupationally acquired illnesses to the WSIB within three days of receiving notification of said illness.

Contacts

Where can I get more information?

It depends on the information you seek.

Surveillance, On-Site Testing, PPE

For information about surveillance (such as, investigation (INV) numbers), on-site testing at the LTC home or PPE requirements and sourcing, contact your established regional contact at Ontario Health at one of the following email addresses below:

Swab Test Kits - To obtain swab testing kits contact your local/regional distribution source or use the online request form, to obtain them directly from Public Health Ontario

Lab Test Results for Staff - Local Public Health Units will notify the LTC home of any positive results.

Any individual with a green Ontario health card (photo card) seeking results of COVID-19 lab tests (including staff members of LTC homes) may visit the COVID-19 Test Results Website. This web-based tool provides access to COVID-19 test results from the Ministry of Health.

Testing of Staff Policy - The Ministry of Long-Term Care Home Action Line/Family Support Line, at 1-866-434-0144, between 8:30 a.m. and 7:00 p.m., seven days a week.

Testing of Residents, Policies for Visitors – Any testing of residents should be according to provincial testing guidance. This and other COVID-19 guidance, including for visitors, can be found here.

Routing and transportation of specimens from LTC facilities to the Provincial Diagnostic Laboratory Network

July 16, 2020

Summary

The following points will help ensure effective processing and optimal turnaround time for surveillance testing of LTC staff:

Lab Role & Responsibilities

All laboratories in the COVID-19 diagnostics network share a common set of responsibilities and expectations related to testing. Community laboratories have assembled guidance documents to support LTC homes; these outline specific processes related to their pickup process and will assist in planning.

Appendix

Completion of the requisition form

Safe Specimen Handling and Transport

Specimens for COVID-19 testing should be handled and transported according to the Transportation of Dangerous Goods Act and its Regulations.

It is the responsibility of the sender to adhere to these Regulations.

Useful tips:

 

For More Information

Call ServiceOntario, Infoline at:
1–866–532–3161 (Toll–free)
In Toronto, (416) 314–5518
TTY 1–800–387–5559.
In Toronto, TTY (416)327–4282
Hours of operation: Monday to Friday, 8:30am – 5:00pm

 
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