question: Do CDC's interim infection prevention and control recommendations for COVID-19 apply to psychiatric hospitals or other behavioral health facilities
answer: Yes. To keep patients and healthcare personnel (HCP) healthy and safe, CDC’s infection prevention and control guidance applies to all settings where healthcare is delivered. However, as with any guidance, facilities can tailor certain recommendations to their setting. For example, inpatient psychiatric care includes communal experiences and group activities that may need to continue. If so, these activities might need to be adapted to align with physical distancing recommendations. Other recommended infection control measures (for example, ensuring access to alcohol-based hand sanitizer, cohorting patients with COVID-19 and assigning dedicated staff, or implementing universal source control measures) might not be safe or appropriate to implement in all locations or for all patients due to security and behavioral concerns. Challenges and potential solutions specific to behavioral health settings might include: Cohorting. Challenge: To prevent transmission, it is generally recommended that patients with SARS-CoV-2 infection be transferred to a separate area of the facility where they can be cared for by dedicated HCP. Because of security concerns or specialized care needs, it might not be possible to cohort certain patients together or change HCP assigned to their care. Potential Solutions: When cohorting is not possible, implement measures to maintain physical distancing (at least 6 feet) between patients with SARS-CoV-2 infection and others on the unit. Ideally, this would include a separate bathroom for patients with SARS-CoV-2 infection. Ensure HCP wear all recommended personal protective equipment (PPE) when caring for patients with suspected or confirmed SARS-CoV-2 infection. Group Therapy Sessions. Challenge: Group counseling, therapy, and discussion sessions are critical components of psychiatric treatment and care plans, but the traditional set-up for these activities is not compatible with physical distancing recommendations. Potential Solutions: When possible, use virtual methods, or decrease group size so physical distancing can be maintained. In the event that SARS-CoV-2 is transmitted in the facility, sessions should stop or move to a video discussion forum until additional infection prevention measures are in place to stop the spread. Source Control. Challenge: For some patients, the use of well-fitting source control (respirators, facemasks or cloth masks) might cause distress or pose an additional danger to themselves or others. Some patients may be unable or unwilling to use them as intended. Elastic and cloth straps can be used for strangling oneself or others, and metal nasal bridges can be used for self-harm or as a weapon. Potential Solutions: Consider allowing patients at low risk for misuse to wear facemasks or cloth masks, with a preference for those with short ear-loops rather than longer ties. Consider use of facemasks or cloth masks during supervised group activities. In areas of substantial to high community transmission, ensure that HCP interacting with patients (who are not suspected or confirmed to have SARS-CoV-2 infection) are still wearing eye protection in addition to well-fitting source control.  HCP should always wear all recommended personal protective equipment (PPE) when caring for patients with suspected or confirmed SARS-CoV-2 infection. Alcohol-based Hand Sanitizer. Challenge: While alcohol-based hand sanitizer (ABHS) containing 60-95% alcohol is an important tool to increase adherence to hand hygiene recommendations, ABHS must be used carefully in psychiatric facilities to ensure it is not ingested by patients. Potential Solutions: Consider not placing ABHS in patients’ rooms in psychiatric facilities, nor in locations where the patients have unsupervised access. Encourage frequent hand washing with soap and water for patients and HCP. Consider providing personal, pocket-sized ABHS dispensers for HCP. Dining. Challenge: As part of physical distancing, communal dining is generally not recommended. However, eating needs to remain supervised due to the potential for self-harm with eating utensils and because commonly used psychiatric medications may cause side effects (e.g., tardive dyskinesia, dysphagia, hypo- and hypersalivation) that increase choking risk for patients. Potential Solutions: One option is to position staff in patients’ rooms to monitor their dining. Another option is to allow communal dining in shifts so that staff can monitor patients while ensuring they remain at least 6 feet apart. A third option is to have patients sit in appropriately spaced chairs in the hallway outside their rooms so they can be monitored while they eat. Smoking. Challenge: A higher proportion of psychiatric patients smoke cigarettes compared to the general population. Patients might congregate in outdoor smoking spaces without practicing appropriate physical distancing. Potential Solutions: Limit the number of patients allowed to access smoking spaces at the same time, and position staff to observe and ensure patients are practicing appropriate physical distancing.