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Coronavirus Disease 2019

Infection Prevention Guidance for Healthcare Personnel

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


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 is required for most HCP per local and state orders. HCP granted an exemption to vaccination must be tested for COVID-19, at least weekly, based on facility type.
  •  HCP who are not fully vaccinated or who have not recently recovered from COVID-19 must quarantine and be excluded from work for 10 days after a work or community exposure with exceptions for critical staffing shortages.

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 fully vaccinated against COVID-19. 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 are not fully vaccinated or have not recently recovered from COVID-19 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 including health care worker vaccination requirements:

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.

Fully Vaccinated HCP

Currently licensed and authorized vaccines in the United States are highly effective at protecting vaccinated people from severe disease and death from COVID-19. Fully vaccinated people are less likely to become infected and, if infected, to develop symptoms of COVID-19. Per the CDC, there is preliminary evidence that suggests that fully vaccinated people who do become infected can be infectious and can spread the virus to others. For this reason, infection prevention measures continue to be necessary for all staff even if fully vaccinated.

Health Care Worker Vaccine Requirement

All persons who work in healthcare facilities must be vaccinated against COVID-19 as required by the California and the LA County Public Health Officers. Workers must receive the final dose of a COVID-19 vaccine series by September 30, 2021. Workers may be exempt from the vaccination requirements based on either a) Religious Beliefs or b) a Qualifying Medical Reason. (See the CDC’s Interim Clinical Considerations for Use of COVID-19 Vaccines for clinical guidance.)

  • A person is considered fully vaccinated against COVID-19 ≥2 weeks following receipt of either: the second dose in a 2-dose EUA COVID-19 vaccine series, one dose of a single-dose EUA COVID-19 vaccine, or after the final dose in a series of a COVID-19 vaccine listed for emergency use by the World Health Organization (See CDC clinical considerations footnote 2 for a list of WHO Emergency use listed (EUL) COVID-19 vaccines).
  • Fully vaccinated HCP must continue to follow all current infection prevention and control recommendations to protect themselves and others from SARS CoV-2 including self-monitoring for symptoms, source control, and testing recommendations as 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, regardless of vaccination status. Well-fitting 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.
  • 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. CDC has also created an FAQ addressing use of 2 masks at the same time to improve the fit of facemasks in a healthcare setting.
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.
  • 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 and Community Exposures
  • HCP that are not fully vaccinated or who have not recently recovered from COVID-19 must quarantine at home and be restricted from work after a high-risk workplace exposure or after close contact to a confirmed COVID-19 case in the community (i.e., community exposure). 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. They can return to work after 10 days have passed from the date of last exposure if they have never had symptoms. Exceptions for staffing shortages may be made (see Facilities Experiencing Staffing Shortages).
  • HCP with other healthcare exposures and HCP that are fully vaccinated or who were previously infected within the last 3 months who have high risk workplace or community exposures do not need to be restricted from work as long as they continue to follow all recommended infection prevention and control practices including universal source control, and continue the monitoring as outlined in this guidance.
    Note: CDC suggests that HCF consider continuing work restrictions for fully vaccinated HCP who have had a high-risk exposure if they have an underlying immunocompromising condition (e.g., organ transplant, cancer treatment).
Definition of High-Risk Occupational and Community Exposure

High-risk occupational 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.

Community Exposure

In the community, a close contact is any of the following persons who were exposed to a laboratory-confirmed COVID-19 case while they were infectious:

  • Persons who were within six (6) feet of the case for a total of 15 minutes or more over a 24-hour period** or
  • Persons who had unprotected contact with the case’s body fluids and/or secretions, for example, being coughed or sneezed on or sharing of a drink or food utensils.

**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.

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. Positive viral tests (NAAT 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.

Post-exposure Testing is recommended for asymptomatic HCP after a high-risk occupational or after a community close-contact exposure to SARS-CoV-2, regardless of vaccination status. Testing also should be performed in response to a cluster of cases meeting the outbreak investigation threshold for hospitals in AFL 20-75.

Screening HCFs are required to routinely test unvaccinated employees that have been granted a vaccine exemption and those who are incompletely vaccinated against COVID-19, pursuant to the State and LA County Orders. CDPH-licensed health facilities must also follow instructions in relevant AFLS. Note that HCP cannot opt to regularly test instead of getting vaccinated.

HCP that are unvaccinated or incompletely vaccinated are required to be tested at least once a week.

  • Acute care hospitals and long-term care facilities must test workers that are not fully vaccinated at least twice a week.
  • All other facilities must test workers that are not fully vaccinated at least once a week.

Note: unvaccinated workers who previously tested positive with a viral COVID-19 test are exempted from this testing only for 90 days from their initial positive test. After 90 days have passed, they must restart testing

Fully Vaccinated HCP

  • Do not need to participate in routine screening testing*
  • If the staff have a severe immunocompromising condition, the facility can consider including them in the routine diagnostic screening testing.

*Fully vaccinated HCP at acute care hospitals, SNFs, and intermediate care facilities must be included in screening testing if vaccination rates at their facility are below 70% for staff at GACH or below 70% for both staff AND residents (SNFs and intermediate care facilities)

Return to work Testing for return to work clearance of confirmed cases is not recommended, see Return to Work Protocol for HCP with Confirmed COVID-19 below.

Recently recovered from COVID-19 Recently infected persons are known to shed non-infectious viral particles for at least 90 days after recovery and reinfection is unlikely to occur during this period. HCP who previously tested positive and are asymptomatic should not be retested for 90 days since the date of symptom onset or date of collection of the first positive viral test. For HCP that develop new symptoms consistent with COVID-19 within 90 days from their prior infection, if an alternative etiology cannot be identified, it is recommended that retesting be done in consultation with infectious disease or infection control experts.

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.

  • 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 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.

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 Exposures

Healthcare facilities experiencing critical staffing shortages may allow HCP in quarantine to return to work using the following shortened quarantine period as long as they remain asymptomatic:

  • After Day 7 from the date of last exposure IF no symptoms were reported during daily monitoring AND after receiving a negative PCR test result on a specimen collected after Day 5 from the date of last exposure.

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 and CDPH Guidance on Isolation and Quarantine for COVID-19 Contact Tracing 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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