Infection Prevention Guidelines for Resumption of …...2020/07/30 · 1 Infection Prevention Guidelines for Resumption of Worship Services and Sacraments within Care Facilities July

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Infection Prevention Guidelines for Resumption

of Worship Services and Sacraments within

Care Facilities

July 30, 2020

The Centers for Disease Control and Prevention (CDC) offer general considerations to help communities of

faith discern how best to practice their beliefs while keeping their staff and congregations safe. Millions of

Americans embrace worship as an essential part of life. For many faith traditions, gathering together for

worship is at the heart of what it means to be a community of faith. But as Americans are now aware,

gatherings present a risk for increasing spread of COVID-19 during this Public Health Emergency. Ministries

wishing to pursue resumption of worship services should do so in accordance with the guidelines from their

local diocese, state and local health departments, and the CDC. When guidelines contradict each other,

always follow the most restrictive guidelines.

Worship services are not to be resumed in a county where the local county dashboard is reporting

more than 100 cases per 100,000 in population.

o Mission leaders are to work with local executive teams to determine the prevalence of

COVID-19 in the county where the facility is located.

o If the community prevalence is greater than 100 cases per 100,000 population, the facility is

to continue to offer services via closed circuit or pre-recording in the patient or resident

rooms.

o Comply with MercyOne policy regarding gatherings.

Local Mission leadership will work with the diocese regarding the resumption of worship services.

Follow all safety protocols as dictated by the diocese.

Comply with all local and state guidelines for religious services, as well as participant limits on

gatherings.

Follow CDC Guidance for Communities of Faith regarding preparing for the resumption of worship

services and ongoing maintenance of healthy operations.

o This guidance includes many critical aspects of operations including:

Initial and ongoing disinfection of facilities and high touch objects

Hand hygiene

Physical distancing

Face coverings

To accommodate patients and residents at higher risk or who aren’t comfortable attending services

in person, continue offering services via closed circuit or pre-recording in patient or resident rooms.

Resumption of Sacraments

The National Association of Catholic Chaplains and the Catholic Health Association of the United States

have also offered guidelines for resuming additional sacramental celebrations.

The Pastoral Care Advisory Committee of the Catholic Health Association, in partnership with the National

https://www.mercyone.org/assets/documents/newsletter/covid-19/mercyone_guidance-for-large-gatherings-06.22.2020.pdf

https://www.cdc.gov/coronavirus/2019-ncov/community/faith-based.html

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Association of Catholic Chaplains (NACC), is pleased to offer the following guidelines for the provision of

sacraments in a health care setting with attention to public health concerns. Mindful of the dignity and value

of those entrusted to our care as well as the unique vulnerabilities of those who are sick, elderly and immune

compromised, the guidelines that follow may be more restrictive than local diocesan guidelines due to their

greater risk for infection than the general population. These enhanced protective measures are intended to

protect those at greater risk of the coronavirus and COVID-19. In making policy decisions, leadership is

encouraged to consider these guidelines along with local diocesan policies and procedures, CDC and local

infection control guidelines, as well as conversations with their local Ordinary who has ultimate authority

over the provision of sacraments in their diocese. We are particularly grateful for the review, questions for

clarification and recommended edits of the guidelines by infection control specialists, the USCCB Episcopal

Liaison to the NACC and the USCCB Office of Worship.

We’ve included these guidelines on the following pages for reference.

Phase Definitions

We’ve added quantitative thresholds to the Phases developed by the Pastoral Care Advisory Committee of

the Catholic Health Association, based on CDC definitions of community transmission. Community

Transmission refers to the prevalence of COVID-19 within the local community and refers to the number of

reported cases per 100,000 in county population. Refer to local executive leadership for assistance with

identifying the community transmission rate.

High community transmission is defined as more than 100 new cases per 100,000 in total county

population over the past two weeks. Phase 1 I the guidelines below applies to areas with high

community transmission.

Moderately high community transmission is defined as >50 to 100 new cases per 100,000 in

county population over the past two weeks. Phase 1 in the guidelines below applies to areas with

moderately high community transmission.

Moderately community transmission is defined as >10 to 50 new cases per 100,000 in county

population over the past two weeks. Phase 2 in guidelines below applies to areas with moderate

community transmission.

Low community transmission is defined as >0 to 10 new cases 100,000 in county population over

the past two weeks. Phase 3 in the guidelines below applies to areas with low community

transmission.

Reference:

CDC: Interim Guidance for Communities of Faith: https://www.cdc.gov/coronavirus/2019-

ncov/community/faith-based.html

CHA: Guidelines for Sacramental Celebrations in a Health Care Setting during COVID-19; June 24, 2020



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General Guidelines

Phase 1* Phase 2* Phase 3*

* Refer to local executive leadership for assistance with identifying the Phase in effect in each area. At

minimum, a region cannot reach Phase 3 until there are less than 100 cases per 100,000 in county population.

Phase 1 refers to the period of “surge” or

extreme pandemic response. This phase

refers to both high and moderately high

community spread (>50->100 cases per

100,000).

Phase 2 refers to the short-term recovery

phases in which both COVID-19 positive

and non-COVID-19 patients are in a

facility. This phase refers to moderate

community spread (>10-50 cases per

100,000).

Phase 3 refers to the long-term recovery

phase in which a facility may or may not

have COVID-19 positive patients but

measures are required to mitigate

exposure and possible transmission.

This phase refers to low community

spread (up to 10 cases per 100,000).

Nature of pastoral

care visits (in person,

routine, by request

and/or virtual)

Refer MercyOne Visitor Guidelines

Spiritual Care

Volunteers

Restricted, consistent with local

volunteer protocols

Volunteer minister services may be

suspended, consistent with local

volunteer protocols.

Remain restricted for LTC and

eldercare

Volunteers may return, consistent

with local volunteer protocols

Clinical Pastoral

Education (CPE)

interns

Restricted, consistent with local

education protocols

CPE intern training may be

suspended, consistent with local

education protocols

Remain restricted for LTC and

eldercare

CPE interns may return, consistent

with local education protocols

CPE residents CPE residency programs may

continue, shifting to virtual

engagement where possible

CPE residency programs may

continue, shifting to virtual

engagement where possible

CPE residency programs may

resume

Distance Physical distancing enforced Physical distancing enforced Physical distancing recommended

Visiting Community

Clergy Refer MercyOne Visitor Guidelines

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Holy Water in Fonts,

Hymnal, Missalettes

Removed Removed Consider individual vials of Holy

Water and/or consider

supplemental chlorination in water,

e.g., 1 part chlorine bleach to 100

parts water.

Literature used for worship

permitted with weekly disinfection

of book (e.g., hymnal) cover

Chapel Access Restricted

Signage placed on entrance doors

asking anyone with COVID-19

Symptoms not to enter the chapel

and stating that face coverings are

required

Chapel capacity and chairs

reduced for physical distance

Chapel only accessible with

restrictions and disinfection

Hand sanitizer should be available

at all entrances

Entrance doors propped open to

limit contact

Chapel (may be streamed) Signage

placed on entrance doors asking

anyone with COVID-19 Symptoms

not to enter the chapel and stating

that face coverings are required






at all entrances.


limit contact

Chapel (may be streamed) Signage

placed on entrance doors asking

anyone with COVID-19 Symptoms

not to enter the chapel and stating

that face coverings are required






at all entrances.


limit contact

Safety Follow institution safety protocols

Face coverings, physical distance,

frequent cleaning required

Restrictions on capacity limits

Follow institution safety protocols


frequent cleaning required

Restrictions on capacity limits

Follow institution safety protocols


frequent cleaning recommended

https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html




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Holy Communion

Phase 1 Phase 2 Phase 3

Phase 1 refers to the period of

“surge” or extreme pandemic

response. This phase refers to both

high and moderately high community

spread (>50->100 cases per

100,000).

Phase 2 refers to the short-term

recovery phases in which both

COVID-19 positive and non-COVID-

19 patients are in a facility. This

phase refers to moderate community

spread (>10-50 cases per 100,000).

Phase 3 refers to the long-term

recovery phase in which a facility may

or may not have COVID-19 positive

patients but measures are required to

mitigate exposure and possible

transmission. This phase refers to

low community spread (up to 10

cases per 100,000).

Reception of Communion Spiritual Communion is

preferred.

Non-COVID patients and non-

PUIs may receive Communion

with specific parameters and

infection prevention procedures.

By request in an emergency or

Spiritual Communion

Non-COVID patients and non-

PUIs may receive Spiritual

Communion or Communion with

specific parameters and clean

procedures in place (see

procedures below).

Ensure new clean procedures in

place when volunteer ministers

of Holy Communion Return

Viaticum Apostolic pardon and Spiritual

Communion are preferred. All

safety and infection control

protocols need to be followed if

Viaticum is administered in

person.

Apostolic pardon and Spiritual

Communion are preferred. All

safety and infection control

protocols need to be followed if

Viaticum is administered in

person.

Resume regular process with

new parameters in place

Visiting Community Clergy Appropriate staff Chaplains

No spiritual care volunteers

Appropriate staff Chaplains

No spiritual care volunteers

Appropriate staff Chaplains

Spiritual care volunteers

permitted with proper training

and safety precautions

Community clergy with proper

training and safety precautions

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Procedures PUI or COVID-19+ Patient

Room Spiritual Communion is

preferred.

Non-PUI, Non-COVID-19+

Patient Room

Face covering and other PPE

as indicated below

Hand hygiene both prior to and

after offering Communion, as

well as before donning and after

doffing gloves.

Carry only ONE individual Host

per pyx, per person into

patient’s room, pyx is

disinfected with approved

disinfection product (see local

Infection Prevention for

guidance).

No Host is returned to

ciborium

Ciborium and

Tabernacle are cleaned

and disinfected regularly

per infection control

protocol

Disposable ritual printouts in

patient room.

PUI or COVID-19+ Patient


preferred.


Patient Room


as indicated below




doffing gloves.







guidance).


ciborium

Ciborium and




protocol


patient room.

PUI or COVID-19+ Patient


preferred.


Patient Room


as indicated below




doffing gloves.







guidance).


ciborium

Ciborium and




protocol


patient room.

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Safely drop the Host in the hand

of the patient without physical

touch. The use of gloves may

be required in a health care

setting based on safety

protocols. Used gloves to be

disposed of per ministry policy.

If patient cannot receive in the

hand, consider Spiritual

Communion.

When exiting the patient room,

the Communion Minister is to

dispose of all items touched by

the patient.




be required in a health care

setting based on safety

protocols. Used gloves to be


If patient cannot receive in the

hand, consider Spiritual

Communion.

When exiting the patient room,

the Communion Minister is to

dispose of all items touched by

the patient.




be required in health care

setting. Used gloves to be


Communion by mouth may be

permitted, with the use of

gloves, Perform hand hygiene

before and after.

In Chapel

Face covering




doffing gloves.

Follow Institution safety

protocols by either carrying one

individual Host per pyx, or when

safe, may carry multiple hosts in

one container, if approved.


ciborium

Ciborium and




protocol

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be required in health care

setting. Used gloves to be


MercyOne’s commitment to

safety is paramount.

Communion by mouth during

celebration of Communion is not

permitted due to infection

control requirements.

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Celebration of Worship Services







100,000).














cases per 100,000).

In Person Attendees Virtual services only Limited to number allowing

physical distancing of local

public health and diocesan

recommendations of capacity

All attendees are encouraged to

wear face coverings

All assistants and clergy wear

procedural masks. Celebrant

may remove their mask while

preaching or reading a sacred

text, if physical distance can be

observed. Celebrants must

perform hand hygiene before

and after removing their mask.

Reconfigure space to allow for

physical distancing

Limited to number allowing

physical distancing of local

public health and diocesan

recommendations capacity

All attendees are encouraged to

wear face coverings

All assistants and clergy wear

procedural masks. Celebrant

may remove their mask while

preaching or reading a sacred

text, if physical distance can be

observed. Celebrants must

perform hand hygiene before

and after removing their mask.

Reconfigure space to allow for

physical distancing

Music Permitted as part of the virtual

services

Since there is evidence that

singing increases the risk of

viral spread, all singing is

suspended during Phase 2.

Singing and all instrumental

accompaniment (including wind

instruments) may resume

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Since music is an important part

of worship, recorded music is

permitted. Instrumental music

may be incorporated, provided it

is with the use of physical

distancing of at least 6 feet,

hand washing, and mask

wearing. Instruments should be

limited to piano (electric or

analog), percussion or strings to

eliminate the need for musicians

to remove their masks or face

coverings.

Communion as part of

worship services (see

additional guidance on

preceding pages)

Spiritual Communion only No physical contact, e.g.,

shaking hands, during the Sign

of Peace

Spiritual Communion may be

preferred in this phase; offer

only Spiritual Communion with

Mass.

High risk age group celebrant

(65+) may defer distribution to

minister/s of Holy Communion.

Hand sanitizer to be used

before, during and after the

distribution of Communion. If

inadvertent contact is made, the

minister of the Holy Communion

is to stop and re-sanitize hands

No physical contact, e.g.,

shaking hands, during the Sign

of Peace

High risk age group celebrant

(65+_ may defer distribution to

minister/s of Holy Communion.

Hand sanitizer to be used

before, during and after the

distribution of Communion. If

inadvertent contact is made, the

minister of Holy Communion is

to stop and re-sanitize hands

continuing to distribute

Communion.

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before continuing to distribute

Communion.

Communion in health care-

based chapels may be required

to receive only in the hand.

Communion will not be

distributed on the tongue.


distributed by the Cup.

Celebrant is required to wear a

procedural mask while

distributing Holy Communion.

Frequently touched surfaces in

the church (pews/pew tops,

door handles, microphones,

etc.) should be cleaned and

sanitized per CDC

recommendations after every

liturgy.

Communion in health care-

based chapels may be required

to receive only in the hand.


distributed by the tongue.


distributed by the Cup.

Celebrant is required to wear a

procedural mask while

distributing Holy Communion.

Frequently touched surfaces in

the church (pews/pew tops,

door handles, microphones,

etc.) should be cleaned and

sanitized per CDC

recommendations after every

liturgy.

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Anointing of the Sick







100,000).














cases per 100,000).

Anointing All Patients

Rare, End of Life exceptions –

seek assistance from clinical

staff in safely donning and

doffing PPE and managing

elements for anointing

Facility visitor restrictions and

available PPE may limit access

by external non-staff clergy

Apostolic Pardon is another

option because it may be

offered remotely or through

physical distance.

PUI or COVID-19+ Patients By

referral




physical distance


Patients

Anointing of the sick as needed

PUI or COVID-19+ Patients By

referral




physical distance


Patients

Anointing of the sick as needed

Minister Only by Priests on staff or

Priests trained on safety

protocols

Priests in risk age group (65+) –

may defer to lower risk group

Only by Priests on staff or


protocols



Any Priest, following all safety

and disinfection protocols

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Procedures Disposable oil container, rituals

and instrument used for

anointing.

Use a cotton swab to apply the

oil. Used items to be disposed

of according to local ministry

policy.

Appropriate PPE

Procedural mask

Sanitize hands before

and after the sacrament

Disposable oil container, rituals


anointing. Use a cotton swab to

apply the oil.

Used items to be disposed of

according to local ministry

policy.

Appropriate PPE

Procedural mask



Disposable oil container, rituals


anointing. Use a cotton swab to

apply the oil.

Used items to be disposed of

according to local ministry

policy.

Appropriate PPE

Procedural mask



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Sacrament of Reconciliation







100,000).














cases per 100,000).

Minister Only by Priests on staff or


protocols





protocols



Facility visitor restrictions and

available PPE may limit access

by external non-staff clergy



protocols



Confession All Patients

Only in an emergency

General absolution with

permission from local Bishop

All Patients

Only in an emergency

General absolution with

permission from local Bishop

Permitted

Procedures Minimum 6 feet distance

Appropriate PPE

Procedural mask



Minimum 6 feet distance

Appropriate PPE

Procedural mask



As requested, keeping physical

distance

Appropriate PPE

Procedural mask



Documents

Infection Prevention Guidelines for Resumption of …...2020/07/30 · 1 Infection Prevention Guidelines for Resumption of Worship Services and Sacraments within Care Facilities July