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Coronavirus Disease 2019

Guidance for Monitoring Healthcare Personnel


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

On 12-21-20

  • Empasizes that vaccinated healthcare personnel (HCP) must continue to follow all infection prevention and control recommendations.
  • Clarifies that COVID-19 vaccine does not cause a positive viral test.

On 12-14-20

  • Includes that afebrile healthcare personnel (HCP) who develop typical vaccine-associated symptoms within 2 days of receiving a COVID-19 vaccination may be permitted to continue to work if they meet specific criteria as outlined in the LAC DPH Guidance, Post Vaccination Assessment of Symptomatic Healthcare Personnel.

On 12-7-20

  • Reduced the quarantine period for HCP to 10 days after exposure.
  • Added an option to reduce the quarantine period for HCP who are close contacts to a household confirmed case when facilities are experiencing staffing shortages.
  • Updated the HCP testing section to include reference to the CDPH acute care hospital testing recommendations.

On 11-12-20

  • Clarification that it is the role of healthcare facilities to assess healthcare personnel (HCP) with possible symptoms of COVID-19 to determine if a medical evaluation and/or COVID-19 testing is needed prior to allowing HCP to work.
  • Recommendation that medical-grade surgical/procedure masks or respirators be used instead of cloth face coverings for universal source control of HCP.
  • Addition that HCP with close-contact to a confirmed COVID-19 case in the community must quarantine at home and be excluded from work for the duration of their quarantine.
  • Addition of guidance for return to work for HCP with symptoms of possible COVID-19.
Key Points
  • Your healthcare facility (HCF) is responsible for developing and executing your facility’s plan to monitor and evaluate healthcare personnel (HCP) for symptoms of possible COVID-19 illness. HCP deemed to have COVID-19 compatible symptoms should not work until the diagnosis has been excluded or they are not considered infectious.
  • HCP refers to clinical and non-clinical staff within your HCF.
  • All HCP should self-monitor twice daily for symptoms, including once prior to starting work, with oversight by your HCF.
  • HCP should wear a medical-grade surgical/procedure mask or respirator for universal source control at all times while they are in the healthcare facility.
  • HCP who are a close contact to a confirmed COVID-19 case in the community or who have a high-risk occupational COVID-19 exposure should be excluded from work for 10 days from last exposure.
Background

Given the continued community spread of COVID-19, HCP may be exposed to COVID-19 in the community or at home and increase the risk of transmission to patients or other HCP. 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 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, and established infection control principles.

In addition to following these HCP monitoring guidelines, HCF are expected to protect their HCP and patients by following CDC and Cal/OSHA COVID-19 infection prevention guidance 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. For more information see:

Recommendations
Vaccinated HCP
  • Currently available COVID-19 vaccines have been shown to be effective at preventing COVID-19 disease and severe illness. However, evidence is currently lacking on the duration of this protection and the vaccine effectiveness at preventing transmission.
  • HCP who have received COVID-19 vaccination (either one or two doses) must continue to follow all current infection prevention and control recommendations to protect themselves and others from SARS CoV-2.
  • All vaccinated staff must continue the daily monitoring, source control, and quarantine recommendations outlined below.
  • Positive viral (molecular or antigen) tests for SARS-CoV-2, if performed, should not be attributed to the COVID-19 vaccine, as vaccination does not affect the results of these tests.
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. Medical-grade masks or respirators are strongly preferred for HCP interacting with patients as non-medical face coverings do not offer reliable protection in higher risk clinical settings. Extended use and reuse of masks and respirators should be done based on principles set forth in prior CDC PPE optimization guidance.
Symptom Monitoring
  • All HCP should self-monitor twice daily (the first time prior to coming to work and the second ideally timed approximately 12 hours later) 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.
  • Prior to the start of their shift, HCF should screen all HCP for symptoms of COVID-19 including a temperature check. 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.
  • Afebrile HCP who develop typical vaccine-associated symptoms within 2 days of receiving a COVID-19 vaccination (e.g., headache, chills, myalgias, arthralgias) may be permitted to continue to work as long as they meet specific criteria as outlined in Post Vaccination Assessment of Symptomatic Healthcare Personnel. Note: cough, shortness of breath, rhinorrhea, sore throat, or loss of taste or smell ARE NOT consistent with COVID-19 vaccination.
Workplace Exposures
  • HCP with high-risk workplace exposures to COVID-19 should be excluded from work and should follow quarantine instructions (see Definition of High-Risk Exposure below). They should be instructed to monitor themselves daily for symptoms consistent with COVID-19 and to immediately contact their established point of contact (e.g. occupational health program) if symptoms develop. HCP can return to work after 10 days if they have never had symptoms. Exceptions for staffing shortages may be made (see Facilities Experiencing Staffing Shortages).
  • HCP with other healthcare exposures have no work restrictions and should continue to follow all recommended infection prevention and control practices including universal source control, and continue the monitoring as outlined in this guidance.
Community Exposures
  • HCP that are a close contact to a confirmed COVID-19 case outside of work (i.e. community exposure) must notify the HCF. They should be excluded from work and follow quarantine instructions. They should be instructed to monitor themselves daily for symptoms consistent with COVID-19 and may return to work after 10 days from their last close contact with the case if they have never developed symptoms. Exceptions for staffing shortages may be made (see Facilities Experiencing Staffing Shortages).
Definition of High-Risk Exposure

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

  1. HCP who performed or were present in the room during a high-risk respiratory aerosol-generating procedure (AGP) where the confirmed case patient was not masked (e.g. intubation or extubation, bronchoscopy, open suctioning) and where the HCP was missing some element of PPE (either eye protection or a respirator). This includes HCP that wore all other recommended PPE but who wore a facemask instead of a respirator during an AGP.
  2. HCP who had close contact (i.e. they were within 6 feet for a cumulative total of 15 minutes or more in a 24-hour period and/or they had direct unprotected contact with infectious secretions/excretions) with a confirmed case:
    1. While not wearing a respirator or facemask
    2. While not wearing eye protection if the case was not wearing a facemask or cloth face covering.

*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.

Testing Recommendations

HCP with any signs or symptoms of COVID-19 should be prioritized for SARS-CoV-2 diagnostic testing (and other respiratory viral testing, such as influenza as indicated), even if the symptoms are mild. Positive viral tests (molecular or antigen tests) in vaccinated HCP should not be attributed to the COVID-19 vaccine as vaccination does not affect the results of these tests.

CDPH recently published a recommendation for weekly testing of HCP in acute care hospitals (AFL 20-88). While all acute care hospitals are required to submit a plan to CDPH to address testing of their HCP, hospitals should weigh the benefits of routine testing against the need to preserve scarce institutional resources when they develop and submit their plan.

Currently, the CDC does not generally recommend testing asymptomatic HCP who had occupational exposures. See CDC Interim Guidance on Testing Healthcare Personnel for SARS-CoV-2. The CDC does recommend testing exposed HCP if quarantine is to be discontinued early, see Facilities Experiencing Staffing Shortages below. Testing for return to work clearance of confirmed cases is not recommended, see Return to Work Protocol for HCP with Confirmed COVID-19 below.

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. SARS-CoV-2 diagnostic viral testing is recommended for HCP with even mild symptoms of possible COVID-19 infection. Symptomatic HCP with compatible symptoms and no clear alternate diagnosis should be told to isolate at home pending clinical evaluation and testing.

  • A single negative SARS-CoV-2 RT-PCR result is adequate to exclude COVID-19 in symptomatic staff with lower epidemiologic risk and/or lower clinical suspicion. A negative test result from a lower sensitivity assay (e.g. antigen tests and some molecular tests), however, should be considered presumptive and confirmation with RT-PCR is recommended.
  • 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 PCR 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 Return to Work: https://www.cdc.gov/coronavirus/2019-ncov/hcp/return-to-work.html

Return to Work Protocol for HCP with Confirmed COVID-19

HCP with mild to moderate illness who are not severely immunocompromised can return to work:

  • At least 10 days after symptom onset AND
  • At least 24 hours since last fever without fever-reducing medication AND
  • Improvement in symptoms.

Asymptomatic HCP who are not severely immunocompromised should be excluded from work until 10 days have passed since the date of their first positive COVID-19 diagnostic test, assuming they have not subsequently developed symptoms. If they develop symptoms, follow above guidance.

Symptomatic HCP with severe or critical illness or who are severely immunocompromised can return to work:

  • At least 20 days after symptom onset AND
  • At least 24 hours since last fever without fever-reducing medication AND
  • Improvement in symptoms.

Note: Asymptomatic HCP who are severely immunocompromised, should wait to return to work until at least 20 days since first positive viral diagnostic test.

For current definitions of COVID-19 illness severity and severely immunocompromised see CDC Return to Work for Healthcare Personnel with SARS-CoV-2 Infection

Return to Work Practices and Work Restrictions

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

Testing of laboratory-confirmed cases is not recommended for return to work due to the prolonged detection of SARS-CoV-2 RNA without direct correlation to viral culture. Refer to the CDC Return to Work for Healthcare Personnel with SARS-CoV-2 Infection for more information on the limitations of using a test-based strategy : https://www.cdc.gov/coronavirus/2019-ncov/healthcare-facilities/hcp-return-work.html

Facilities Experiencing Staffing Shortages

Employers must be prepared for staffing shortages and have plans and processes in place to mitigate them. Every effort should be made to limit exposure to both patients and facility HCP. Refer to the CDC Strategies to Mitigate Healthcare Personnel Staffing Shortages for protocols on contingency and crisis strategies for mitigating staffing shortages.

HCP in Quarantine for High Risk Workplace or Community Non-Household Exposures

Healthcare facilities experiencing staffing shortages of essential HCP may allow the following HCP to continue to work during their quarantine period as long as they remain asymptomatic:

  • Those with high-risk workplace exposures to SARS-CoV-2
  • Those with close contact exposure to a non-household confirmed COVID-19 case

These HCP must observe strict infection control procedures including source control at all times (facemask or respirator required) while working. They must adhere to full home quarantine when not doing their essential work. They must continue regular daily symptom monitoring and if symptoms occur within 14 days of the exposure, they must be immediately excluded from work and told to isolate at home pending clinical evaluation and testing.

*HCP who are close-contacts to a household confirmed case (i.e., the HCP lives with the infected person) should not work during their quarantine period. A shorter quarantine is acceptable during staffing shortages, see below.

HCP in Quarantine for Community Household Exposure

HCP who are close contacts to a household confirmed case (i.e., the HCP lives with the infected person). These HCP may return to work:

  • After day 7-- if no symptoms have been reported during daily monitoring AND after a negative PCR test collected on day 5 or later.

These HCP must observe strict infection control procedures including source control at all times (facemask or respirator required) while working. They must continue regular daily symptom monitoring and if symptoms occur within 14 days of the exposure, they must be immediately excluded from work and told to isolate at home pending clinical evaluation and testing.

See CDC Options to Reduce Quarantine for Contacts of Persons with SARS-CoV-2 Infection Using Symptom Monitoring and Diagnostic Testing for more information.

HCP with Confirmed COVID-19 Infection

HCP who are infected with SARS-CoV-2 should be excluded from work until they meet all return to work criteria (as outlined above). If extreme shortages continue despite all other mitigation strategies, facilities may consider following CDC crisis capacity strategies to mitigate severe staffing shortages. See CDC Strategies to Mitigate Healthcare Personnel Staffing Shortages

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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