Long-Term Care Reopening Survey

Question Title

* 1. My facility’s primary supplier is having difficulty filling our orders for the following PPE (Select all that apply)

Face masks

N95s

Gowns

Gloves

Eye protection

Question Title

* 2. The state is our primary supplier for the following PPE (Select all that apply)

Face masks

N95

Gowns

Gloves

Eye protection

Question Title

* 3. We have chosen not to return to conventional or contingency standards for PPE use because we want to be prepared for further PPE shortages.

True

False

Question Title

* 4. My facility continues to reuse PPE by removing (i.e. doffing) and using them again (Select all that apply)

Face masks

N95

Gowns (cloth gowns that are removed and laundered do not count)

Gloves

Eye protection

Question Title

* 5. If a facility does not have an outbreak of COVID-19, the facility is required to use gowns for (Select all that apply)

Persons under observation/quarantine for COVID-19

Persons suspected or confirmed to have COVID-19

When entering the room of all residents in the facility

All high-contact patient care activities, including dressing, bathing/showering, transferring, providing hygiene, changing linens, changing briefs or assisting with toileting, device care or use, and wound care.

Question Title

* 6. My facility uses which gown types (Select all that apply)

Cloth gowns

Disposable isolation gowns

Isolation gown alternatives

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* 7. My facility is extending the use of isolation gowns such that the same gown is worn by the same HCP when interacting with multiple patients (Select all that apply)

For suspected COVID + residents

For confirmed COVID + residents

For all residents

For residents on observation

Question Title

* 8. My facility is reusing isolation gowns by wearing the same gown multiple times before disposal or laundry.

Yes

Question Title

* 9. My facility has not moved into phase one of relaxing restrictions because (Select all that apply)

We have had a facility-onset case in the last 14 days

We are still using crisis standards of care for PPE use

We do not have adequate staffing at our facility

Our local hospital does not have adequate capacity to accept admissions

We do not have a space for cohorting and managing the care of residents with COVID-19

We do not have the capacity to test all of our staff on a weekly basis