COVID-19 Response Improvement Action Checklist
for the Elderly in Long Term Care Facilities★ Purpose of this checklist:
This action checklist is intended to visualize priority items when voluntarily working to strengthen COVID-19
response at elderly in long term care facilities. It was developed to create consensus towards next
actionable steps.
It has been developed as a checklist in which you can choose the improvement ideas that should beimplemented at your workplace. It is effective when being used in a group discussion setting among yourcolleagues. Each item has been derived from practical measures in real workplaces against COVID-19 andhas been categorized into use for administrators and staff. This action checklist can promote COVID-19 risk
mitigation measures that are tailored to your workplace.

★ How to use this checklist:
1. Read each item carefully. Check each item on the list to determine whether each measure has alreadybeen implemented at your workplace or a new measure must be implemented in place going forward. (thisstep is individual work).
2. Discuss the results of the checklist with other members. Discuss what measures can be implemented atyour workplace (this step is group work).
3. For already existing good practices, discuss how you might be able to strengthen those measures at yourworkplace. For those measures that must be put in place, prioritize and make plans for immediate action.
4. Begin working on feasible measures, especially those that were marked priority.

★ Points to remember when using this checklist:● Action checklist is not for evaluating the quality of your workplace's COVID-19 response measures. It is atool to facilitate feasible risk mitigation measures that is right for your workplace.
●It is important to focus on the existing good practices in your workplace. It should be emphasized thatlooking at achievements rather than pointing out shortcomings always promotes positive and constructive
thinking that leads to concrete improvements.
● This checklist is not an exhaustive list of all necessary measures. You can take parts of this action
checklist, change the order of items, etc. to make it most useful for your workplace.
●Management needs to comply with national legal obligations in establishing their workplace COVID-19prevention and control plan.

The use of this action list is free and does not need to get authorization.
However, if you have made changes to the list, please do not list our names to the new checklist.
Contact: Sanae Matsunaga, E-mail: palausanae@gmail.com

A. For facility adminitrator/Infection control staff

COVID-19 Response Improvement Action Checklist for the Elderly in Long Term Care Facilities
Place：【How to use thechecklist】【Marking the checklist】（Recommended paper size: A3）

Date：
This action checklist was developed to prevent the outbreak of COVID-19 at long term care facilities. The action checklist can be used by reviewing the risk mitigation measures below and discussing amongst your colleagues. For those measures that are already in place,discuss how you might be able to strengthen the existing efforts. For those measures that are not in place, prioritize and agree on specific actionable steps that can begin today.

●If the measure has already been implemented properly or is not needed, mark NO under "Do you propose action?"●If you think the measure would be worthwhile, mark YES.

Use the space under Remarks to add comments, describe a situation, or add a suggestion.

【Selecting piorities】

After you have finished, review the items you have marked YES. Choose several items for which the benefits seem to be most important. Mark PRIORITY for these items. (Get through to here in about 10 minutes)【Group discussion aboutthe results】

Discuss the checked results jointly with other members. Agree on existing good practices and on actions to be taken based on the checklist result.
Communicate with manager and staff members about the proposed solutions and follow up on implementing these actions. (Spend about 35 minutes)
Do you propose action?

A.
Organization

B.
Health management
for members of thestaff
C.
Safe and healthy
work environment

D.
Health Management
for facility users
E.
Emergency
preparedness forwhen cases occur

NO

YES

PRIORITY□□□□□□□□□□

1.

Assign a person in charge of infection control and notify everyone of their roles.

2.
3.
4.

Create a contact-list of local medical facilities, care facilities, and health centers and post it.
Provide information regularly regarding the epidemic infectious diseases and their prevention practices.
Have communication daily regarding transmission reduction measures between the manager and infection control staff members.

5.

Share a flow chart of how to respond to an infection outbreak in the facility.

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6.

Prepare in advance the Busineess/care Continuty Plan (BCP) for when a case is found at the facility.

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7.

Respond to external questions, such as those from families and external partners who are involved in facility operations.

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8.

Build relationships with infectious disease experts to exchange information about infection control for COVID-19□□□

1.

Check the health condition of members of the staff (including external contractors) every day.

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2.

Establish a protcol for when to suspend and return to work for staff members who were exposed and have had close contact with COVID-19 cases or have developed symptoms.
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3.

Establish procedures of infection control for staff members (Standard Precaution and transmission based precautions).

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□

4.

Train staff members on necessary infection control practices and check them every day.

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1.

Identify 3C conditions (Crowded places, Close-contact settings, Confined and enclosed spaces) and avoid these situations/conditions.

□□

□

2.
3.

Ensure opportunities for staff members to share concerns and worries regularly .
Establish a flexible shift schedule and workflow so that work can be covered when someone gets sick.

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4.

Secure required number of Personal Protective Equipment (PPE) for staff members.

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□

1.

Inform infection prevention measures to facility users and their families.

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□

2.

Establish rules around visitations (check health status before the visitation, mask-wearing, standards for when visitations will not be allowed, etc.).

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3.

Update emergency contact addresses and telephone numbers for clients' families.

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□

1.

Establish emergency steps for what to do when suspected cases arise (reporting, seeking physicians, collecting samples from suspected cases by doctors/nurses)

2.
3.

Conduct training in advance on how to isolate, set zoning, and allocate staff members when suspected cases arise.
Set up a response taskforce with the head of the facility in charge when suspected cases arise.

□□□□□□□□□4.

Consult with collaborating physicians or local health centers when suspected cases arise.

□□

□

5.
6.

Create response records immediately when a suspected case arises.
Isolate suspected cases to an appropriate space so that they will not infect others.

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□

□
□

7.

Establish a protocol for responding to staff members, families of users, and media when suspected cases arise.

□□□

Authors：Sanae Matsunaga (Miyagi University/Tohoku University), Yumiko Zanma (Saka General Hospital), Retsu Fujita (International University of Health and Welfare), Go Mutou (Kitasato University),Etsuko Yoshikawa (Japan Red Cross College of Nursing), Koji Kato (International University of Health and Welfare) / Created July 2020
Health and Labor Sciences Research Grant. This was developed by PI Yasuyuki Kato and contributor Koji Wada who researched on clinical response in preparation in case of when patients of Category I infectious diseases occur (20HA2002).

Remark

B. For staff

COVID-19 Response Improvement Action Checklist for the Elderly in Long Term Care Facilities （Recommended paper size: A3）
Place：Date：【How to use thechecklist】

This action checklist was developed to prevent the outbreak of COVID-19 at long term care facilities. The action checklist can be used by reviewing the risk mitigation measures below and discussing amongst yourcolleagues. For those measures that are already in place, discuss how you might be able to strengthen the existing efforts. For those measures that are not in place, prioritize and agree on specific actionable steps that canbegin today.

【Marking thechecklist】●If the measure has already been implemented properly or is not needed, mark NO under "Do you propose action?"【Selecting piorities】【Group discussionabout the results】●If you think the measure would be worthwhile, mark YES.

Use the space under Remarks to add comments, describe a situation, or add a suggestion.

After you have finished, review the items you have marked YES. Choose several items for which the benefits seem to be most important. Mark PRIORITY for these items. (Get through to here in about 10 minutes)
Discuss the checked results jointly with other members. Agree on existing good practices and on actions to be taken based on the checklist result.
Communicate with manager and staff members about the proposed solutions and follow up on implementing these actions. (Spend about 35 minutes)
Do you propose action?

A.
My HealthManagemtent

NOYESPRIORITY

1. Check my health status every day, and will not go into work if I am having any symptoms.

□□□

2. Consult employment regulation for the date to return to work after I was showing symptoms and had stayed home.

□□

□

□

□

□

□

□

□

5. Prepare a sufficient number of uniforms so that they can be washed daily and wash them at the end of each work shift.

□□□

6. Change into personal clothes immediately upon returning home if you commute in your uniform.

□□□

1. Check the health status of users and halt usage of the facility by those who have developed symptoms.
2. Notify rules around visitations (check health status before the visitation, short visitation times, standards for when visitations
will
not be allowed).
3. Place alcohol based handrub to readily available round the facility.

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□

□

□

□

□

□

□

4. Record and manage in and out of users (name, visitation time/date, visitation duration, contact).

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5. Consider whether an alternative service might be necessary for users with symptoms, and help to coordinate such alternative
services if necessary.

□□□□

□

□

3. Avoid going to situations that meet the 3C conditions (Crowded places, Close-contact settings, Confined and enclosed spaces)
even outside of work hours.
4. Wear masks during work.

B.
HealthManagement forfacility users

1. Limit contact to a minimum by keeping as much distance as possible from one another at work including during breaks orC.
changing clothes.
Safe and Healthy
work environment 2. Be cognizant and work towards keeping staff stations and other areas used by staff organized, maintained, and clean.

D.
Infection Controlfor Covid-19

□

□

□

3. Ensure opportunities for staff members to share concerns and worries regularly .

□

□

□

4. Plan work management so that operations can continue even if some members of the staff suddenly take sick leave.

□□□

1. Conduct appropriate hand hygiene practices (hand washing with soap and water or hand hygiene with alcohol-based handrub).

□□□2. Learn how to properly don and doff PPE, and do them appropriately for each care.

□□□

3. List up PPE that is needed for each care procedure.

□□□

4. Establish washing and disinfecting methods for items that need to be re-used and develop a manual.

□□□

5. Instruct users on proper handwashing and coughing etiquette.

□□□

6. Wipe and disinfect high-frequency contact surfaces in each work shift.
(doorknobs, handrails, light switches, tables, bed frames, keyboards, mice, phones, rehabilitation equipment, etc.)□□□

7. Ensure good ventilation by allowing outside air in twice every hour or so. If that is difficult, use a ventilation fan.

□□□

8. Handle and wash contaminated linens using gloves, masks, plastic aprons making sure that the contamination does not spread.

□□□

9. Reduce the number of shared items as much as possible, or wash/disinfect after every use.

□□□

10. Do simulation exercise to follow specific steps when you have a suspected case (reporting, seeing a physician, method ofsample collection)□□□

Authors：Sanae Matsunaga (Miyagi University/Tohoku University), Yumiko Zanma (Saka General Hospital), Retsu Fujita (International University of Health and Welfare), Go Mutou (Kitasato University),
Etsuko Yoshikawa (Japan Red Cross College of Nursing), Koji Wada (International University of Health and Welfare) / Created July 2020
Health and Labor Sciences Research Grant. This was developed by PI Yasuyuki Kato and contributor Koji Wada who researched on clinical response in preparation in case of when patients of Category I infectious diseases occur (20HA2002).

Remark