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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:

2-23-23

  • Removed the requirement that healthcare facilities must screen healthcare personnel for symptoms prior to entry. Facilities need to have a way to communicate that healthcare personnel with symptoms of COVID-19 and/or a positive COVID-19 test must not enter the premises.
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 must wear a medical-grade surgical/procedure mask or respirator for universal source control while they are in the healthcare facility. N95 respirators are required in certain situations.
  • COVID-19 vaccination, including a booster dose, is required for HCP per local and state orders.
Background

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. 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.

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 stay up to date with recommended COVID-19 boosters. The bivalent booster is, however, strongly recommended.

Workers who are newly coming into compliance with the State and Local healthcare worker 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 must 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 must 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.
  • HCP returning to work after a COVID-19 infection are required to wear a fit-tested N95 for source control through Day 10. Similarly, exposed HCP who are working during their post-exposure testing period should also wear a N95 respirator for source control at all times while in the facility until they have a negative test result on day 5.
Symptom Monitoring
  • HCF need to communicate that HCP with symptoms of COVID-19 and/or a positive COVID-19 test must not enter the premises.
  • All HCP should routinely self-monitor for symptoms of possible COVID-19.
  • HCP with symptoms of possible COVID-19 should be restricted from work pending SARS-CoV-2 diagnostic testing. 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 SARS-CoV-2 diagnostic testing. See Return to Work for Symptomatic HCP.
Management of Asymptomatic Exposed HCP

HCP with higher risk occupational exposures and those with close contact exposures outside of work (community exposures) may continue to work, regardless of vaccination status, as long as they do not develop symptoms or test positive for SARS-CoV-2. Serial post-exposure testing is required. HCF should follow the table below to guide the management of asymptomatic HCP with exposures based upon the facility staffing level.

All HCP with exposures should wear an N95 respirator at all times while in the facility until they have a negative test result on Day 5.

Table 1. Management of Asymptomatic HCP with Exposures                                                    
Vaccination Status Routine Critical Staffing Shortage
All HCP, regardless of vaccination status No work restriction with negative diagnostic test upon identification (but not earlier than 24 hours after exposure) and if negative, test at days 3 and 5. No work restriction with diagnostic test upon identification (but not earlier than 24 hours after exposure) and at days 3 and 5.^

Either an antigen test or nucleic acid amplification test (NAAT) can be used. In general, post exposure testing of asymptomatic HCP who have recovered from SARS-CoV-2 infection in the prior 30 days is not recommended. If the exposed HCP’s first positive prior test was 31-90 days ago, then antigen testing is recommended.

^ If most recent test is positive, see Table 2 Work Restrictions for HCP with SARS-CoV-2 Infection.

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

HCP who are close contacts in the community are considered higher risk. This is because at work, HCP must follow infection control prevention and control procedures and they use personal protective equipment (PPE) per strict standards. To see the definition of a close contact in the community, see CDPH Guidance on Isolation and Quarantine of the General Public.

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. Management of Asymptomatic HCP with Exposures. 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

HCP with symptoms of COVID-19 should be excluded from work pending SARS-CoV-2 diagnostic testing.

  • A single negative NAAT result is sufficient to allow return to work in most circumstances. If there is a higher level of clinical suspicion for SARS-CoV-2 infection, consider maintaining work restrictions and confirming with a second negative NAAT.
  • A negative antigen test result should be confirmed by either a negative NAAT or a second negative antigen test collected 48 hours after the first negative test prior to return to work.

For HCP who were initially suspected of having COVID-19 but, following evaluation, another diagnosis is suspected or confirmed, 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
All HCP, regardless of vaccination status 5 days* with at least one 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. This may not apply for staff types or in settings where practically infeasible (e.g., Emergency Departments where patient COVID status is unknown) or where doing so would disrupt safe nurse to patient ratios, and for staff who do not have direct patient/resident care roles. The HCP 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 until at least 10 days from symptoms onset or positive test (for HCP who remain asymptomatic throughout their infection).

HCP returning to work between days 5-9 after meeting routine criteria should wear a fit-tested N95 for source control through at least Day 10 from symptoms onset or positive test (for HCP who remain asymptomatic throughout their infection).

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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