Updated guidance released Friday by the Centers for Medicare & Medicaid Services gives nursing homes more options for conducting a COVID-19 outbreak investigation after a positive test occurs.

Providers can now perform outbreak testing through two different approaches: contract tracing or broad-based, facility wide testing, upon the identification of a single new case of COVID-19 in any staff or residents. 

Previous guidance required providers to immediately test all staff and residents in response to an outbreak. All staff that tested negative also were required to be retested every three to seven days until testing showed no more new cases among the group for at least 14 days after the first positive result. 

The new guidance states that if the facility has the ability to identify close contacts of the individual with COVID-19 then leaders there can choose to conduct focused testing based on known close contacts. If the facility doesn’t have the expertise or resources to do that, it should investigate the outbreak facility-wide or at a group level. 

“Broader approaches might also be required if the facility is directed to do so by the jurisdiction’s public health authority, or in situations where all potential contacts are unable to be identified, are too numerous to manage, or when contact tracing fails to halt transmission,” the guidance states. 

The updated guidance also revised COVID-19 staff testing frequency to be based on the facility’s country level of community transmission instead of county test positivity rate.