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Coronavirus Disease 2019

Infection Prevention Guidance for Healthcare Personnel


11-1-22: LAC DPH is aware of the updated CDC guidance for healthcare personnel and healthcare settings. California regulations are currently more restrictive than CDC guidance and must continue to be followed. This includes masking indoors in healthcare settings and work restrictions for exposed and infected staff based on HCP vaccination status and facility staffing level.

Summary of Recent Changes
Significant changes to this guidance include the following:

9-21-22

Key Points
  • Your healthcare facility (HCF) is responsible for developing and executing your facility’s plan to decrease risk of COVID exposure from potentially infectious healthcare personnel (HCP).
  • HCP refers to clinical and non-clinical staff within your HCF.
  • All HCP should self-monitor for symptoms of COVID-19
  • HCP should wear a medical-grade surgical/procedure mask or respirator for universal source control while they are in the healthcare facility.
  • COVID-19 vaccination, including a booster dose, is required for HCP per local and state orders.
  • Asymptomatic HCP who have not completed a COVID-19 primary series and received a booster dose and who have not been infected with SARS-CoV-2 within the past 90 days must be excluded from work for 7 days after a higher-risk work or community exposure with exceptions for critical staffing shortages.
Background

HCP may be exposed to COVID-19 in the community or at home and increase the risk of transmission to patients or other HCP, especially if they are not up to date with their COVID-19 vaccinations. Exposures encountered by HCP at work are unlike those that might occur in the community because HCF follow infection control prevention and control procedures and HCP use personal protective equipment (PPE) per strict standards. Due to their often extensive and close contact with vulnerable individuals, HCP with symptoms of possible COVID-19 illness and those with community or high-risk occupational exposures who have not received a COVID-19 vaccine booster (if eligible) should be managed more conservatively.

These guidelines have evolved as a result of greater experience with COVID-19, the availability of published data on COVID-19, continued evidence of community transmission of COVID-19 including asymptomatic and pre-symptomatic transmission of more infectious variants, established infection control principles, and the availability of effective COVID-19 vaccines.

In addition to following these HCP guidelines, HCF are required to follow State and Local Health Officer Orders and All Facilities Letters (AFLs) including health care worker vaccination requirements and return to work for exposed and infected HCP:

They are also expected to follow CDC and Cal/OSHA COVID-19 infection prevention guidance and requirements including universal use of PPE for patient care, use of N95 respirators for the care of suspect or confirmed COVID-19 cases, and routine respirator fit testing.

Employers and facilities can have policies that are stricter than those required by State and County Health Officer Orders and Cal/OSHA or recommended by the CDC.

COVID-19 Vaccination

CDC, CDPH, and LAC DPH urge everyone to remain up to date with COVID-19 vaccination, including the most recent booster dose to protect themselves and reduce the spread of the virus. At this point in time, the updated (bivalent) booster is recommended for all persons aged 12 and older at least 2 months after their last vaccine dose (either the final primary series dose or the last booster). See CDC Stay Up to Date with COVID-19 Vaccines Including Boosters for more information. Visit LAC DPH Vaccine Schedule website for easy-to-read color schedules in English and Spanish.

If a worker is newly coming into compliance with the State and Local health care worker vaccine requirements, then they are required to receive the fall bivalent booster when eligible. See below.

Health Care Worker Vaccine Requirement

All persons who work in healthcare facilities must complete a primary COVID-19 vaccine series and receive a single booster dose as required by the California and the LA County Public Health Officers.

Workers who are already in compliance with the vaccine requirement (i.e., completed a primary series and received a single booster) are not required to receive the bivalent COVID-19 booster. The bivalent booster is, however, strongly recommended.

Workers who are newly coming into compliance with the vaccine requirements must receive their booster dose within 15 days after becoming eligible. HCP who have completed their primary series who provide proof of subsequent COVID-19 infection may defer this booster administration for up to 90 days after infection. The 90 days are from the onset of the initial COVID-19 symptoms. If they never had symptoms, then the 90 days are from the date of collection of the first positive viral COVID-19 test.

Workers may be exempt from the vaccination requirements based on either a) Religious Beliefs or b) a Qualifying Medical Reason.

For details, please refer to the orders and related resources:

  • LA County Healthcare Worker Vaccination Requirement Order
  • State Health Care Worker Vaccine Requirement Order and FAQs
Source Control
  • HCPs should wear medical-grade surgical/procedure masks or respirators for universal source control at all times while they are in the healthcare facility, regardless of vaccination status. Healthcare facilities should make N95 respirators available to any HCP who wishes to wear one when not otherwise required for the care of patients or residents with suspected or confirmed COVID-19.
  • When a surgical facemask is worn, it is important that it fits well. For more information refer to guidance in the CDC Interim Infection Prevention & Control Recommendations.
  • N95 respirators should be worn while caring for patients with possible or confirmed COVID-19.
Symptom Monitoring
  • All HCP should routinely self-monitor for symptoms of possible COVID-19.
  • HCP with symptoms of possible COVID-19 should contact the HCF before presenting for work. It is recommended that symptomatic HCP be assessed by a clinician. The clinician should determine if further medical evaluation and COVID-19 testing is needed prior to allowing the HCP to work. See Return to Work for Symptomatic HCP.
  • Prior to the start of their shift, HCF should screen all HCP for symptoms of COVID-19. Temperature checks of HCP prior to work is helpful in ensuring a healthy workforce but is of unclear benefit in the setting of a highly vaccinated workforce and is not required. HCF should perform a risk assessment to determine the most effective methodologies to protect HCP and patients within their facilities. HCF should develop and implement screening systems that cause the least amount of delay and disruption as possible (e.g., HCP self-report, single use disposable thermometers, or thermal scanners).
  • If HCP develop symptoms of possible COVID-19 while at work, they should keep their mask/respirator on and notify their supervisor to arrange leaving the workplace and obtaining medical evaluation and/or COVID-19 testing as appropriate.
Exposed HCP - Quarantine and Return to Work

Asymptomatic HCP with higher-risk workplace exposures or community exposures are managed more conservatively if they are unvaccinated OR if they are vaccinated and booster eligible but have not yet received their booster dose.

HCF should follow the table below to guide the management and work restrictions for asymptomatic HCP with high-risk exposures based upon their vaccination status, recent infection history, and facility staffing level.  

There are no work restrictions for HCP with a lower risk exposure. However, all HCP with exposure to SARS-CoV-2 who are not restricted from work should follow all recommended infection prevention and control practices, including wearing well-fitting source control (respirator preferred), monitoring themselves for fever or symptoms consistent with COVID-19, and not reporting to work when ill or if testing positive for SARS-CoV-2 infection.

Table 1. Work Restrictions for Asymptomatic HCP with High-Risk Exposures (Quarantine)
Vaccination Status Routine Critical Staffing Shortage
Received all primary series doses and a booster OR received all primary series doses and not booster-eligible No work restriction with negative diagnostic test upon identification and at 5-7 days No work restriction with diagnostic test upon identification and at 5-7 days
Unvaccinated§ OR incompletely vaccinated§ OR received all primary series doses and is booster-eligible but have not yet received a booster dose§ 7 days with diagnostic test upon identification and negative diagnostic test within 48 hours prior to return No work restriction^ with diagnostic test upon identification and at 5-7 days

§In general, asymptomatic HCP who have recovered from SARS-CoV-2 infection in the prior 90 days do not require work restriction nor testing following a higher-risk exposure. Consider antigen testing if the exposed HCP’s first positive prior test was 31-90 days ago.

^HCP working during their quarantine period should wear a N95 respirator for source control at all times while in the facility until they meet routine return-to-work criteria.

Exposure Risk Assessment for HCP

Higher-risk occupational exposure

In the healthcare setting, the following exposures to a confirmed infectious COVID-19 case* are considered high-risk:

  1. HCP not wearing a respirator (or if wearing a facemask, the person with SARS-CoV-2 infection was not wearing a cloth mask or facemask).
  2. HCP not wearing eye protection if the person with SARS-CoV-2 infection was not wearing a cloth mask or facemask.
  3. HCP not wearing all recommended PPE (i.e., gown, gloves, eye protection, respirator) while performing an aerosol-generating procedure.

*COVID-19 cases are considered to be infectious beginning 2 days prior to symptom onset (or initial positive viral test if case is asymptomatic) until the time they meet criteria for discontinuing isolation.

Community Exposure

Community exposures include exposures outside of work (e.g., household) and among HCP exposed to each other while working in non-patient care areas (e.g., administrative offices). Community exposures are considered higher-risk exposures if they meet the following definition of a close contact:

  • They were within six (6) feet of an infectious case* for a cumulative total of 15 minutes or more over a 24-hour period**.

**This is regardless of use of face masks of the case or contact.

*COVID-19 cases are considered to be infectious beginning 2 days prior to symptom onset (or initial positive viral test if case is asymptomatic) until the time they meet criteria for discontinuing isolation.

For more information, see the CDPH AFL:

Testing Recommendations

Symptomatic persons Regardless of vaccination status, HCP with any signs or symptoms of COVID-19 should be prioritized for SARS-CoV-2 viral testing (and other respiratory viral testing, such as influenza, as indicated), even if the symptoms are mild.

HCP with SARS-CoV-2 infection Testing is required for return to work prior to completing the 10-day isolation. See Table 2. Work Restrictions for HCP with SARS-CoV-2 Infection (Isolation).

Post-exposure Testing is required* for asymptomatic HCP after a high-risk occupational or community close-contact exposure to SARS-CoV-2 as outlined in Table 1. Work Restrictions for Asymptomatic HCP with Exposures (Quarantine). Testing also should be performed in response to a cluster of cases meeting the outbreak investigation threshold for hospitals in AFL 20-75.

Screening of asymptomatic HCP is no longer routinely recommended except in outbreak investigations. During periods of high community transmission of COVID-19, LAC DPH may recommend this practice.

Return to Work for Symptomatic HCP

HCF should have a plan to evaluate HCP with symptoms of possible COVID-19 illness. It is recommended that symptomatic HCP be evaluated by a clinician. Symptomatic HCP with compatible symptoms and no clear alternate diagnosis should be told to isolate at home pending clinical evaluation and testing results.

  • A single negative sensitive SARS-CoV-2 NAAT result is adequate to exclude COVID-19 in symptomatic staff with lower epidemiologic risk and/or lower clinical suspicion.
  • Two negative RT-PCR tests at least 24 hours apart are recommended to exclude COVID-19 in HCP with higher clinical suspicion and/or higher epidemiologic risk.

For HCP who had symptoms of possible COVID-19 and had it ruled out, either with negative test(s) and/or with a clinical assessment that COVID-19 is not suspected (e.g., clear alternate diagnosis), then return to work decisions should be based on their other suspected or confirmed diagnoses.

See CDC Interim Guidance for Managing HCP with SARS-CoV-2 Infection.

Return to Work Protocol for HCP with Confirmed COVID-19
Table 2. Work Restrictions for HCP with SARS-CoV-2 Infection (Isolation)                                
Vaccination Status Routine Critical Staffing Shortage
Received all primary series doses and a booster OR received all primary series doses and not booster-eligible 5 days* with negative diagnostic test† same day or within 24 hours prior to return OR
10 days without a viral test
<5 days with most recent diagnostic test result to prioritize staff placement
Unvaccinated OR incompletely vaccinated OR received all primary series doses and is booster-eligible but have not yet received a booster dose 7 days* with negative diagnostic test† same day or within 24 hours prior to return OR
10 days without a viral test
5 days with most recent diagnostic test result to prioritize staff placement

*Asymptomatic or mildly symptomatic with improving symptoms and meeting negative test criteria; facilities should refer to CDC guidance for HCP with severe to critical illness or moderately to severely immunocompromised.

† Either an antigen test or nucleic acid amplification test (NAAT) can be used. Some people may be beyond the period of expected infectiousness but remain NAAT positive for an extended period. Antigen tests typically have a more rapid turnaround time but are often less sensitive than NAAT. Antigen testing is preferred for discontinuation of isolation and return-to-work for SARS-CoV-2 infected HCP and for HCP who have recovered from SARS-CoV-2 infection in the prior 90 days; NAAT is also acceptable if done and negative within 48h of return. 

‡ If most recent test is positive, then HCP may provide direct care only for patients/residents with confirmed SARS-CoV-2 infection, preferably in a cohort setting. 

HCP whose most recent test is positive and are working before meeting routine return-to-work criteria must maintain separation from other HCP as much as possible (for example, use a separate breakroom and restroom) and wear a N95 respirator for source control at all times while in the facility. In addition, healthcare facilities should make N95 respirators available to any HCP who wishes to wear one when not otherwise required for the care of patients or residents with suspected or confirmed COVID-19.  

Return to Work Practices and Work Restrictions

  • HCP with confirmed COVID-19 do not need medical or LAC DPH clearance to return to work.
Contact Us

If you have questions, email LAC DPH at hcwcontacts@ph.lacounty.gov or call at 213-240-7941.


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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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