Nursing home infections spread while state inspectors lack PPE

By: - March 30, 2020 4:45 pm

Iowa Governor Kim Reynolds gives an update on COVID-19 at the State Emergency Operations Center in Johnston, Iowa, on March 30, 2020. (Zach Boyden-Holmes/Pool, The Register)

The COVID-19 pandemic continued to spread in Iowa nursing homes Monday, even as state inspectors relied on the facilities themselves to provide them with personal protective equipment.

Gov. Kim Reynolds said Monday that an outbreak of COVID-19 has been confirmed in a Cedar Rapids nursing home. She said 21 of Linn County’s 71 confirmed cases are now believed to be related to that outbreak.

So far, six Iowa nursing homes have reported at least one positive COVID-19 staff member or resident. Fourteen individuals — six residents and eight staff members — at the six Iowa facilities have tested positive.

The agency that inspects Iowa nursing homes said Monday that its inspectors do not have any personal protective equipment to use when they go inside nursing homes — and said that in some cases such equipment is unnecessary.

“We do not have PPE at this time,” said Department of Inspections and Appeals spokeswoman Stefanie Bond. “In some cases, it is not needed. In others, a facility may provide PPE for the (inspectors).”

On March 4, the federal Centers for Medicare and Medicaid Services issued a directive to DIA and other state inspection agencies that said they must “ensure (inspection) team members have needed personal protective equipment that may be required onsite to observe resident care in close quarters. If the facility has gowns, gloves, face shields or other eye protection that may be used by surveyors, such PPE may be used onsite by surveyors.”

The inspectors’ reliance on nursing homes’ infection-control equipment coincides with a recent directive from CMS instructing the inspectors to focus on homes and hospitals that in the past three years have been cited for the most serious infection-control violations.

Reynolds said Monday she believes DIA is adequately equipped and is increasing its oversight of homes with infection-control issues as mandated by the federal government’s Centers for Medicare and Medicaid Services.

“DIA is staffed and equipped to handle that,” she said. “They have been working closely with CMS to really implement all of the guidelines. They have followed exactly what CMS and the CDC have recommended, so they’ve been in close consultation with them throughout the whole process to make sure we’re following the guidelines that we are implementing.”

Reynolds said she doesn’t know how many Iowa care facilities in Iowa are subject to the new oversight requirements that focus on homes cited for serious infection-control violations at some point in the past three years.

CMS says state agencies like DIA are “constantly evaluating” their inspectors to ensure they’re unlikely to transmit a virus when entering a facility.

The federal agency says that while state inspectors may have been in a different care facility with COVID-19 cases during the previous 14 days, the fact that they wore PPE means that “they pose a low risk of transmission in the next facility, and must be allowed to enter.”

Reynolds asks Iowans to sew face masks

Also on Monday, Reynolds asked Iowans for their help with the creation of homemade PPE for Iowa’s hospitals.

“If you can sew, we need your time and talent to produce face masks for Iowa’s frontline workers,” she said. “If you’re willing and able, we need your help.”

The governor said instructions are available online, and homemade masks can be donated to the hospital of the donor’s choosing. The Iowa Department of Public Health website has some design guidance.

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Clark Kauffman
Clark Kauffman

Deputy Editor Clark Kauffman has worked during the past 30 years as both an investigative reporter and editorial writer at two of Iowa’s largest newspapers, the Des Moines Register and the Quad-City Times. He has won numerous state and national awards for reporting and editorial writing. His 2004 series on prosecutorial misconduct in Iowa was named a finalist for the Pulitzer Prize for Investigative Reporting. From October 2018 through November 2019, Kauffman was an assistant ombudsman for the Iowa Office of Ombudsman, an agency that investigates citizens’ complaints of wrongdoing within state and local government agencies.