Summary of Recent Changes
Significant changes to this guidance include the following:
These guidelines are intended to support healthcare facilities and EMS Provider Agencies (both referred to as HCF for short in this guidance) with locations in LA County.
HCF are required to follow County COVID-19 Health Officer Orders, California All Facilities Letters (AFLs), and Cal/OSHA regulations including the return to work for exposed and infected workers:
Where the requirements differ, the more stringent (protective) directives apply.
HCF are required to also follow the Cal/OSHA Aerosol Transmissible Disease (ATD) standard that require the use of N95 respirators for worker protection during the care of suspect or confirmed COVID-19 cases. Finally, HCF should refer to the following CDC COVID-19 guidelines for healthcare personnel:
Employers and facilities can have policies that are more protective than those required by County Health Officer Orders, CA AFLs, and Cal/OSHA or recommended by the CDC.
HCP with 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.
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.
SNFs must and other HCFs should determine the exposure risk for HCP with potential exposure to a confirmed COVID-19 case in a health care setting (see box). CDPH guidance for assessing community-related exposures should continue to be applied to HCP with potential exposures outside of work and among HCP exposed to each other while working in non-patient care areas (e.g., administrative offices). To see the definition of a close contact in the community, see CDPH Guidance on Isolation and Quarantine of the General Public.
Exposure Risk Assessment for HCP
In the healthcare setting, the following exposures to a confirmed infectious COVID-19 case* are considered high-risk:
*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.
See CDC for more details regarding risk assessment of exposed HCP: cdc.gov/coronavirus/2019-ncov/hcp/guidance-risk-assesment-hcp.html
HCP with higher-risk exposures may continue to work, as long as they do not develop symptoms or test positive for SARS-CoV-2. SNFs must and other HCFs should follow the table below to guide the management of asymptomatic HCP with exposures based upon the facility/agency staffing level.
Exposed HCP should wear a mask at all times while at work around others (including non-patients) through Day 10. To provide an additional layer of safety, an N95 respirator is recommended 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.
HCP with SARS-CoV-2 infection must be excluded from the workplace for at least 5 days and at least one negative diagnostic test is required prior return to the workplace before Day 10, with exceptions for critical staffing shortages. SNFs must and other HCFs should follow the table below to guide the return to work based upon the facility/agency staffing level.
HCP returning to work after meeting routine criteria must wear a mask at all times while at work around others (including non-patients) through at least Day 10. To provide an additional layer of safety, a fit-tested N95 is recommended. Note: an N95 is required for source control for infected HCP permitted to return to work before meeting routine criteria (i.e., critical staffing shortage.
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 return-to-work testing 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.
‡ Critical staffing shortages: 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 they meet routine return to work criteria).
If you have questions, email LAC DPH at ACDCPhyConsult@ph.lacounty.gov or call at 213-240-7941.