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Reporting LAHAN Alerts

Non-Residential Settings

B73 COVID-19 - Procedural Guidance for DPH Staff



Non-Residential Settings (including Worksites, Food Service Facilities, and Places of Worship).
For Adult Day Care facilities, please visit the Adult Day Care B73 page.

Forms / Quick Links

  • COVID-19 Outbreak Non-Residential Settings PDF
  • COVID-19 Outbreak Form Guidance PDF
  • COVID-19 Line List for Non-Residential Congregate Settings Excel
  • Coronavirus (COVID-19) Death Report Form PDF
  • Resources (intranet access required)

REPORTING PROCEDURES

Outbreak Definitions

Under Title 17, Section 2500, California Code of Regulations - all suspected outbreaks are reportable.

At least 3 laboratory-confirmed cases with symptomatic or asymptomatic COVID-19 within a 14-day period who are epidemiologically linked, who do not share a household, and are not close contacts of each other outside of the outbreak site (except when housing or transportation is provided by the employer); OR at least 5% of the facility census are laboratory-confirmed cases (symptomatic or asymptomatic), with a minimum of 5 laboratory-confirmed, within a 14-day period, and in the absence of identifiable epidemiological links.

NOTE: Epidemiologically linked cases include persons with identifiable connections to each other, such as being present the same setting during the same time period (e.g., same shift/department, same physical work area) within likely timing of exposure and without other more likely sources of exposure. Epidemiologic links indicate a higher likelihood of transmission of disease between cases compared to sporadic incidence. Cases sharing housing or transportation provided by the employer are evaluated as individual cases as employer-provided facilities are considered an extension of the worksite.

Symptomatic illness compatible with COVID-19:
  • At least two of the following symptoms: fever (measured or subjective), chills, rigors, myalgia, headache, sore throat, nausea or vomiting, diarrhea, fatigue, congestion or runny nose; OR
  • At least one of the following symptoms: cough, shortness of breath, difficulty breathing, or new olfactory and taste disorder(s); OR
  • Severe respiratory illness with at least one of the following: clinical or radiographic evidence of pneumonia or acute respiratory distress syndrome (ARDS).

Epidemiologic Data for Outbreaks

  1. Complete COVID-19 Line List for Non-Residential Congregate Settings (see Forms) that includes:
    1. Name
    2. Date of birth or age
    3. Address and phone number
    4. Job duties
    5. Work location
    6. Dates worked at facility
    7. Specimen collection date (COVID-19 test date)
    8. Symptom status and onset date
    9. Hospitalization and fatality
    10. Results of laboratory tests
    11. Vaccination status and date of last dose
  2. Document suspected and confirmed cases on the Case Line List and contacts on the Contact Outbreak Line List in the COVID-19 Line List for Non-Residential Congregate Settings (see Forms). The Other Employees line list can be completed for documenting mass testing or matching full employee lists to IRIS case surveillance data or other purpose as needed.
  3. Obtain site floor plan, if appropriate.
  4. Maintain surveillance until there are no new outbreak-associated cases for at least 2 weeks from last exposure in a facility (see Closing Outbreaks). Last exposure refers to the latest (most-recent) day any outbreak-associated case was present at the facility while infectious.
  5. Create an epi-curve using the symptom onset date, if available, or the first positive specimen collection date (whichever date is earlier). (Optional)
  6. Complete COVID-19 Outbreak Non-Residential Settings form at the conclusion of investigation (see Report Forms).

GENERAL INVESTIGATION GUIDELINES

  1. Communications to ACDC regarding outbreaks in non-residential settings can be directed to:
    1. FoodSafety@ph.lacounty.gov for restaurants, grocery stores, food processing/manufacturing, or food warehouses; and
    2. ACDCVector@ph.lacounty.gov for most other worksites.
    3. Additional ACDC outbreak teams for special settings (e.g. HOBR team for places of worship, gyms, mass transit and ticketed and non-ticketed events).
  2. Investigation can be conducted over the phone. Consider field visits or virtual visits under circumstances that warrant closer observation including non-compliance, uncontained spread of COVID-19, and increased risk of spread to the public.
  3. As deemed necessary by outbreak team leaders, conduct immediate interview of cases to obtain information regarding job duties, contacts, dates of attendance, and other critical information.
  4. The frequency of follow-up with the facility or site coordinator for outbreak updates, including requesting updated line lists, should be at least weekly (but may be more frequent initially), as needed by the Outbreak Management Branch (OMB) MD..
  5. ACDC will immediately notify the Division of Environmental Health (EH) upon opening an outbreak. Site visits may be conducted independently, or jointly, by OMB and EH.
    1. Upon notification of an outbreak, OMB will contact EH immediately to coordinate a joint site visit, if needed.
    2.  OMB and EH will conduct a joint site visit for outbreaks determined to be high priority. See High Priority Outbreaks for definition.
    3. Communications to EH (EHSurvey@ph.lacounty.gov) must include the following information:
      • IRIS Outbreak #
      • Facility's name and address
      • Name of facility's point of contact
      • Phone number of point of contact
      • Email of of point of contact
      • Description of each OB zone
      • Number of cases in each OB zone
      • Number of employees in each OB zone
      • Total number of cases (entire facility)
      • Total number of onsite employees (entire facility)
      • Summary of known information
      • OMB PHI & MD
      • Specific request(s) from EH (e.g. request for a joint site visit with EH)
  6. Inform the facility, or site, that they will be included on a public outbreak notification list posted on the LAC Public Health website until the facility meets criteria for closing outbreaks (see Closing Outbreaks).
  7. Outbreaks identified as high priority must be immediately reported to ACDC and the Division of Environmental Health. See High Priority Outbreaks section for definition and additional response.
  8. Immediately notify ACDC and EH if OMB has determined a need for a DPH-ordered closure due to circumstances that prevent the facility to safely operate as noted in Criteria for Closing Facilities.
  9. Notify ACDC within 24 hours of identification of any of following:
    1. Concerning issues of non-compliance
    2. Significant increase in case counts
    3. Outbreak has been open for more than 4 weeks
    4. Voluntary facility closures that are planned to last longer than 48 hours
  10. If during the course of investigation, OMB determines that the outbreak does not meet outbreak criteria, please consult with ACDC, so that ACDC may review findings and make a final determination on whether outbreak should be closed as false.

Additional guidance and resources:

GENERAL CONTROL RECOMMENDATIONS FOR OUTBREAKS

  1. DPH testing recommendations should be communicated to the facility administrator/manager or site coordinator.
  2. Targeted testing is recommended for close contacts in all non-residential congregate settings. Targeted testing does not impact duration of quarantine as testing does not predict if a close contact will develop disease during the incubation period. (See Testing Considerations for guidance on employees who have been vaccinated or previously tested positive for SARS-CoV-2).
  3. Reinforce masking, social distancing, and good hand hygiene among all (including clients, customers, and vendors).
  4. Emphasize respiratory etiquette (cover cough and sneezes, dispose of tissues properly).
  5. Sick persons (including clients, customers and vendors) with any illness, even with mild symptoms, should be restricted from entering the facility/site and urged to stay home and self-isolate.
  6. Screen all employees, and if feasible also clients, customers and vendors, for symptoms. Consider checking for fever by measuring body temperature..
  7. Urge employees to quarantine at home if someone in their house is sick (see Quarantine Instructions for Contacts)..
  8. Emphasize importance of early detection of cases and removing them from contact with others.
  9. Ensure adequate and easily accessible supplies for good hygiene, including:
    1. Tissues and trash receptacles
    2. No touch hand sanitizer dispenser near customer entrances, if feasible
    3. Handwashing stations
    4. Soap
    5. Paper towels
    6. Alcohol‐based hand sanitizer
  10. Provide employees, and, if possible, clients, customers and vendors,  with accurate and updated Public Health information and materials about novel coronavirus. Signage should be posted at the site to reinforce frequent hand washing, cover your cough and maintain social distancing.
  11. Minimize, where possible, close contact and the sharing of objects such as cups, food, and drink (see Reopening Protocols for each setting).
  12. Temporary closing of the facility or site for 24-48 hours can be considered in order to perform thorough environmental cleaning and disinfection of all surfaces and objects including doorknobs/pushbars, elevator buttons, phones, restroom doors, faucet handles, counters etc. Use cleaning chemicals with EPA-registered disinfectant labels with claims against emerging viral pathogens (see www.epa.gov/pesticide-registration/list-n-disinfectants-use-against-sars-cov-2). Temporary closure is not essential as long as environmental cleaning can be appropriately conducted.
  13. Increase site wide routine cleaning and disinfection of all frequently touched surfaces and objects to three times per day.
  14. Clean touchable shared equipment between shifts or between users, whichever is more frequent, including but not limited to working surfaces, tools, handles and latches, and controls on stationary and mobile equipment.
  15. Notify all employees of COVID-19 outbreak at site while maintaining patient privacy and reinforce prevention measures across the facility/site. A template for employers to draft notification on company letterhead is available if needed. Employers must submit a draft template in legible font (size 14 or larger) to DPH for approval prior to distributing or posting. See COVID-19 Template for Notification to Visitors and Employees in Additional Guidance and Resources.
  16. Post a notification letter of outbreak in visible public areas including but not limited to the entrance(s) of the facility/site and community areas (see COVID-19 Template for Notification to Visitors and Employees in Additional Guidance and Resources and refer to instructions in Bullet 15).
  17. Issue a public notification regarding on-site exposures if unidentifiable employees, attendees, clients or customers may have been close contacts. Examples of a public notification include, but are not limited to, issuing a press release, using social media, and/or including information in communications released to the public and/or customer list.
  18. Assess if there are shared spaces that are used by persons at nearby sites, including but not limited to employees of other businesses or residents living in a multiuse building. Shared spaces include, but are not limited to bathrooms, breakrooms, conference rooms and kitchens. Instruct management at the outbreak location that notices should be posted alerting persons to COVID-19 exposure in these shared spaces. See Exposure Notification Poster.
  19. Implement strategies to protect employees who are at higher risk for adverse health complications. This may include strategies such as telecommuting, staggering shifts, and cross training staff.
  20. Instruct site to maintain daily visitor log, if feasible, with date and time of visit.

HIGH PRIORITY OUTBREAKS

  1. A worksite outbreak is classified as high priority if, during the outbreak investigation, a facility is associated with:
    1. 10 or more confirmed COVID-19 cases occurring in the outbreak zone of a facility within a 14-day period
    2. Worksite closures, either voluntary or ordered by LAC DPH, for any reason
    3. Identification of a noteworthy COVID-19 variant from one or more outbreak-associated cases
    4. Special circumstances (i.e. a sensitive environment or population, significant political or media attention, notable fatalities or other complications, etc.)
  2. Other considerations that may qualify a worksite outbreak as high priority include:
    1. The majority of employees at the facility are not represented by a union, are low-wage workers, or are working in a high-risk setting (e.g. employees are in close contact with others indoors, require frequent contact with others in daily work tasks). These settings often include those in the manufacturing and warehousing sectors.
    2. Labor partners, or other external groups, have elevated their concerns to elected officials or to DPH.
    3. Significant media interest.
    4. OMB or ACDC determines that the outbreak should be included on the list.
  3. Immediately notify EH of the high priority outbreak to prioritize a joint site visit.
  4. OMB to complete a high priority log report to submit to the Policy Group by the evening prior to the next log report update. Written reports will include the latest information about the latest data from the facility (e.g., case count, number of deaths, number of workers tested), a plan for ensuring the worksite comes into compliance, and a description of any enforcement actions that should be taken.

 

CONTROL OF CASE, CONTACTS & CARRIERS

Cases

  1. Instruct employees with confirmed COVID-19 and any ill employees with symptoms suggestive of respiratory illness to self-isolate at home.
    1. Laboratory-confirmed cases should not return to site for at least 10 days after symptom onset and 24 hours after fever has resolved (without use of fever reducing medicines) and symptoms have improved. For asymptomatic positive cases, the specimen collection date may be used instead of the symptom onset date. See Home Isolation Instructions.
    2. Laboratory-confirmed cases who are asymptomatic and have previously tested positive for SARS-CoV-2 within the past 90 days do not need to isolate again.
    3. Symptomatic cases that test negative or indeterminate/inconclusive for SARS-CoV-2 should not return to work until at least 24 hours after fever has resolved without the use of fever-reducing medication. It is strongly recommended that those with indeterminate or inconclusive SARS-CoV-2 results have repeat testing.
  2. Employer, or site coordinator, should recommend testing for all symptomatic employees even if they have been fully vaccinated (at least 2 weeks have passed since the final dose of their vaccine series).  They can be referred to their primary care provider or 2-1-1 to access county or city testing resources. Testing is not generally available at Public Health Laboratory for congregate settings that are non-residential or non-healthcare.
  3. If the employee came to the site while ill, they should be separated from others with door closed, masked, and directed to go home right away.
  4. Determine when the employee was first symptomatic and when they were tested.
  5. Determine which days or shifts the case was on site.
  6. If ill person has severe symptoms, call 9-1-1. Notify EMS and the receiving healthcare facility of possible exposures.
  7. Consider alternative work options like teleworking if employee is well enough to do so.
  8. Instruct employee case to notify all other employers of their illness in order to initiate contact investigations or other necessary infection control measures.
  9. Document suspected and confirmed cases, regardless of prior testing or vaccination status, on the Case Line List in the COVID-19 Line List for Non-Residential Congregate Settings (see Forms). (See Determining Outbreak-Associated Cases and Outbreak Zone section).
  10. Even if COVID-19 testing is negative for a symptomatic employee, utilize the symptom-based clearance strategy in bullet 1 for return to work.
  11. Instruct the employer to notify the public health outbreak manager assigned to the facility immediately if any additional employees or contacts, if known, test positive for COVID-19.

Contact

A close contact is a person with exposure to a confirmed or suspected case of COVID-19 during the period of infectiousness of the case. This is from 2 days before symptom onset (or date of first positive lab test for asymptomatic persons) until the case meets criteria for discontinuing isolation/transmission-based precautions.
Exposures are generally defined as:

  1. An individual who was within 6 feet of the case for a total of 15 minutes or more within a 24 hour period regardless of whether someone is masked or not;
  2. An individual who had unprotected contact with the case’s body fluids and/or secretions, for example, being coughed or sneezed on, sharing utensils or saliva, or providing care without wearing appropriate protective equipment.
Note: A person is still considered exposed even if the case or the contact was wearing a mask or whether the contact was wearing respiratory personal protective equipment (unless they are healthcare workers/trained in wearing respiratory PPE).

Quarantine Instructions for Contacts

  1. Close contacts who are asymptomatic should be instructed to stay home in quarantine for 10 days after last exposure to a suspected or confirmed case. (See Home Quarantine Guidance.) Note that guidance for the general community requires quarantine only for contacts to confirmed and physician-diagnosed cases. Quarantine is still recommended for close contacts of all suspected, symptomatic cases in an outbreak setting because there is a higher pre-test probability of positive infection.
  2. Testing is recommended for symptomatic close contacts, regardless of vaccination status or history of prior infections. Asymptomatic close contacts who have not been fully vaccinated nor have had a positive test within the last 90 days should also be recommended for testing. They can be referred to their primary care provider or 2-1-1 to access county or city resources for testing.
  3. If quarantined contacts test positive or develop symptoms of respiratory illness (fever and cough or shortness of breath), then they should begin self-isolation as instructed above for cases. (Also see Home Isolation Instructions.)
  4. Asymptomatic close contacts who are fully vaccinated or have tested positive for SARS-CoV-2 within the last 90 days do not need to quarantine after exposure to a case, nor test in most circumstances. See Testing Considerations for further guidance.

    Note: CDC does not recommend testing, symptom monitoring or special management for people exposed to asymptomatic people with potential exposures to SARS-CoV-2 (i.e., "contacts of contacts"), these people are not considered exposed to SARS-CoV-2.

Contact Investigation

  1. Employers or site coordinators should initiate contact investigation around each suspected or confirmed case to identify all close contacts associated with the site (employee or client/customer/vendor) during the infectious period of the case(s).
    1. In instances where there is a known suspected or confirmed COVID-19 case in a client, customer or vendor, the employer or site coordinator should initiate investigation to identify exposed persons at site.
  2. Employers should instruct contacts to self-quarantine for 10 days after last exposure (see above Quarantine Instructions for Contacts).
    1. If direct communication with exposed contacts is possible, a template letter for notification and instructions for reporting symptoms or positive test results back to facility or site coordinator can be provided as a guide for messaging.
    2. If exposed contacts cannot be individually contacted or none could be identified, a template letter for general notification and instructions for self-monitoring can be provided as a guide for messaging to employees.
  3. Exposed employees in all industries, including those employed in critical infrastructure such as food services, transportation, government services, and other sectors, must self-quarantine.
    1. Contacts who are healthcare personnel (HCP) or first responders (e.g., EMS and fire department) may continue to work after exposure if there is a critical staffing shortage and if they remain asymptomatic. Note that this guidance is more restrictive than CDC guidance cdc.gov/coronavirus/2019-ncov/community/critical-workers/implementing-safety-practices.html.
    2. Requests for asymptomatic contacts who work in critical infrastructure to continue work must be reviewed and approved by the OMB MD and ACDC.
  4. Clients, customers and vendors (i.e., non-staff): Contact any clients, customers and vendors that may have been exposed to a suspected or confirmed case.
    1. Advise contacts to self-quarantine for 10 days after last exposure (see above Quarantine Instructions for Contacts). Clients, customers and vendors should call their primary care provider or 2-1-1 to discuss testing options.
    2. If direct communication with exposed contacts is possible, a template letter for notification and instructions for reporting symptoms or positive test results to the facility can be provided to contact as a guide for messaging.
    3. If exposed contacts cannot be identified or contacted, a template letter for general notification and instructions for self-monitoring can be provided as a guide for messaging. A notification poster can also be posted (see Exposure Notification Poster.)
  5. Document the contacts on the Contact Outbreak Line List in the COVID-19 Line List for Non-Residential Congregate Settings (see Forms), regardless of prior testing or vaccination status, and submit it to DPH Case/Contact Interview Branch (CCIB) as soon as possible.
  6. Employer, or site coordinator, should recommend testing for employee contacts who had exposure to a site-associated COVID-19 case.
    1. If testing identifies additional cases, a new contact investigation is initiated around the new case to identify, isolate, and test their close contacts. This protocol is repeated for each identified case at the workplace.
    2. Asymptomatic close contacts who test negative cannot return to site and must complete their 10-day quarantine.
  7. See Quarantine Instructions for Contacts and Testing Considerations below for additional guidance for asymptomatic close contacts who are fully vaccinated or have previously tested positive for SARS-CoV-2.
  8. Do not require a healthcare provider's note for employees to return to work.
  9. Discontinue all group events (See Reopening Protocols for each setting).

TESTING CONSIDERATIONS

  1. DPH recommendations for targeted testing should be communicated to the facility administrator/manager or site coordinator (see Responding to COVID-19 in the Workplace).
  2. Employer or site coordinator should recommend testing for all employee contacts who had exposure to a site-associated COVID-19 case in accordance with current public health guidance (see link to testing guidance). Employer can refer employees to any of the following for testing:
    1. Primary care provider
    2. Employer occupational health
    3. 2-1-1 for county or city testing sites
  3. Employers may request that employees report their test results (see cdflaborlaw.com/_images/content/DFEH-Employment-Information-on-COVID-19-FAQ_ENG.pdf and www.eeoc.gov/wysk/what-you-should-know-about-covid-19-and-ada-rehabilitation-act-and-other-eeo-laws). Employers must maintain confidentiality in compliance with privacy laws.
  4. Asymptomatic employees who are fully vaccinated or have previously tested positive for SARS-CoV-2 within the past 90 days, do not need to test in most circumstances. However, these employees can be considered for testing if they are identified as a close contact in certain high-risk settings or  outbreak situations, including, but not limited to, high-priority outbreaks, facilities with low adherence to protocols, facilities with a large number of unvaccinated employees, manufacturing facilities, or outbreaks involving variants of concern.
  5. Retesting of contacts is not recommended if they remain asymptomatic from date of exposure to end of quarantine period. Retesting is recommended if any of the contacts become symptomatic.
  6. Site-wide testing may be considered in unique situations (e.g. if outbreak is extensive or close contacts are not identifiable due to nature of exposures). Employees participating in site-wide testing can be documented in the Other Employees list in the COVID-19 Line List for Non-Residential Congregate Settings (see Forms).
  7. Document pertinent COVID-19 testing practices and testing history that the facility has performed in IRIS including:
    1. Whether targeted testing was conducted
    2. Whether wider testing (e.g. mass testing) was conducted
    3. Dates of targeted or mass testing
    4. Number of employees tested
    5. Test results

DETERMINING OUTBREAK-ASSOCIATED CASES AND OUTBEAK ZONES (OB ZONES)

  1. If the boundaries of an outbreak can be characterized in smaller, more specific area(s) of a facility rather than the entire worksite, an outbreak zone (OB zone) can be used to monitor the outbreak. Cases associated with the OB zone are followed as outbreak-associated cases and outbreaks can be closed when there are no new cases associated with the OB zone by the end of the surveillance period. a. ACDC will define the OB zone, if applicable to the setting, when the outbreak is opened.
    1. ACDC will define the OB zone, if applicable to the setting, when the outbreak is opened.
    2. OMB can redefine the OB zone as needed upon further investigation.
    3. Additionally, OMB can expand the outbreak during the course of the investigation to include new OB zone(s) if a new epi-linked cluster of 3 or more cases within a 14-day period occurs outside of the previously identified OB zone.
  2. The start of an active outbreak is defined as the earliest date any case among the initial epi-linked cluster was present at the facility while infectious. The first case of an outbreak may have occurred prior to the identified epi-linked cluster. Sporadic case/cases occurring prior to the epi-linked cluster should be considered part of the outbreak if there is an identifiable epi-link between the sporadic case to a case in the cluster or a subsequent outbreak-associated case and the epi-linked cases are within 14 days of each other.
  3. All cases associated with the defined outbreak area (the facility or OB zone) occurring with a symptom onset or positive test after the first case, regardless of whether they are epi-linked, should be counted as part of the outbreak until the end of the surveillance period. The surveillance period ends 14 days from the latest day any case associated with the defined outbreak area was on-site while infectious (i.e. last exposure in a facility).
  4. The cases that determine the start of an outbreak and the end of the surveillance period may not necessarily be the first and last case of the outbreak, respectively, as they may have left the facility and developed illness many days later.
  5. Cases that can be excluded from the outbreak and do not need further investigation include those who cannot be associated with the facility during their exposure period in which they could acquire SARS-CoV-2 infection nor the infectious period in which they could transmit it to another employee. These cases can be documented in the Other Employees line list in the COVID-19 Line List for Non-Residential Congregate Settings (see Forms). The following cases can be excluded:
    1. Cases who previously tested positive in the past 90 days and are asymptomatic.
    2. Cases that were not on-site at any time during their exposure period. The exposure period begins 14 days prior to the episode onset date. Episode onset is the date of symptom onset or positive specimen collection date—whichever is earlier.
    3. Cases with household contact to a COVID-19 positive employee or non-employee who had episode onset after the household contact AND within the case’s exposure period AND the case was not present on-site during their infectious period. The infectious period begins two days prior to episode onset. For example, case was already in quarantine due to exposure to household contact.
    4. Cases with private carpool contact to a COVID-positive employee while the COVID-positive employee was infectious AND exposure occurred within the exposure period of case AND case was not present on-site during their infectious period.
  6. Outbreak-associated cases are those who can be associated with the defined outbreak area either during their exposure period or the infectious period. They are defined as:
    1. Cases whose primary work location is within the defined outbreak area (the facility or the OB zone) with an episode onset date after the OB start date, OR
    2. Cases whose primary work location is outside of the defined OB area, but are epi-linked to the outbreak at any time within their exposure period or infectious period.
    3. Special Considerations:
      • Cases who carpool together in private vehicles or are from same household and have an episode onset within a 14-day period:
        1. If cases have the same episode onset date, designate those that work primarily within the defined outbreak area as OB-associated (e.g., employees testing positive during mass testing) and those that primarily worked outside of the defined outbreak area as not OB-associated.
        2. If cases have different episode onset dates, the case with the earliest episode onset should be designated as OB-associated if they work primarily within the defined outbreak area. Subsequent cases who primarily work within the defined outbreak area can also be designated as OB-associated if they were present on-site during infectious period given the risk of subsequent worksite transmission to others. All other cases can be designated as not OB-associated including subsequent cases that were not present on-site during their infectious period.
      • Cases that result from secondary transmission from an OB-associated case and use shared housing facilities (e.g., migrant labor camps, man camps) or shared transportation services, provided by the employer, should be designated OB-associated.
  7. Cases that are not OB-associated may still have acquired or transmitted SARS-CoV-2 infection at the facility and should remain on the Case Line List for continued evaluation. Cases that are not outbreak-associated cases are:
    1. Cases whose primary work location is within the defined outbreak area but have episode onset before OB start date (i.e., a previous case in the outbreak location one month earlier).
    2. Cases whose primary work location is outside of the defined outbreak area and are not epi-linked to an OB-associated case.

CRITERIA FOR CLOSING FACILITIES

  1. Temporary closing of the facility or site for 24-48 hours can be considered in order to perform thorough environmental cleaning and disinfecting of equipment and other frequently-touched surfaces and objects, such as: doorknobs/push-bars, elevator buttons, restroom doors, etc. Use EPA-registered chemical disinfectants to combat emerging viral pathogens XX (see epa.gov/pesticide-registration/list-n-disinfectants-use-against-sars-cov-2).
    1. In most cases, a temporary closure is not essential if environmental cleaning and other standard infection control measures, including deep-cleaning of COVID-19 case’s work and shared spaces, can be appropriately conducted without closure.
    2. Notify ACDC immediately if the facility plans to close longer than 48 hours—either voluntarily or by recommendation, such as for extensive environmental cleaning.
  2. If OMB determines an ordered closure is needed because certain circumstances prevent the facility from operating safely, immediately notify EH and ACDC and initiate the closure protocol. Facilities may be ordered to close temporarily under the following circumstances:
    1. Magnitude of outbreak and/or lack of disease-control measures that significantly increase the risk of continued disease transmission.
    2. New case(s) identified above baseline, despite implementation of outbreak-control measures.
    3. Inability of facility to implement outbreak-control measures recommended by DPH.
    4. Absence of clear, timely updates or communication from the facility to DPH
  3. If EH or ACDC have reason to believe that a facility that is experiencing an outbreak should be closed, OMB will immediately be notified and OMB will initiate closure protocol.

DEATH REPORTING

The Public Health outbreak manager must be notified of a death associated with the facility.

 

CLOSING OUTBREAKS

  1. The last day of surveillance is the 14th day after the last date that any outbreak-associated case was on site.
  2. New cases occurring during the 14-day surveillance period should be evaluated as described in Determining Outbreak-Associated Cases and Outbreak Zones.
  3. The  outbreak can be closed if all conditions below are met:
    1. No cases  have occurred in the defined outbreak area within the 14-day surveillance period; and
    2. No cases  outside of the defined outbreak area are epi-linked to the defined outbreak area or to an outbreak-associated case within the 14-day surveillance period; and
    3. No additional clusters of 3 or more cases that meet outbreak criteria are identified in other areas of the facility; and
    4. The location appears to have effectively implemented all necessary COVID-19 control and preventive measures and observed violations have been abated.

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  • Public Health has made reasonable efforts to provide accurate translation. However, no computerized translation is perfect and is not intended to replace traditional translation methods. If questions arise concerning the accuracy of the information, please refer to the English edition of the website, which is the official version.

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