Coronavirus Disease 2019

Health care personnel (HCP) are defined by the Centers for Disease Control and Prevention (CDC) as including but not limited to: emergency medical service personnel, nurses, nursing assistants, physicians, technicians, therapists, phlebotomists, pharmacists, students and trainees, contractual staff not employed by the healthcare facility, and persons not directly involved in patient care, but who could be exposed to infectious agents that can be transmitted in the healthcare setting (e.g., clerical, dietary, environmental services, laundry, security, engineering and facilities management, administrative, billing, and volunteer personnel).

The definition of an outpatient healthcare facility (HCF) outbreak is where there are 3 or more confirmed COVID-19 cases in patients and/or HCP with evidence of epidemiological linkage. Epidemiological linkage is defined as a potential common area of contact (e.g., same nursing unit, shared break room) or contact with same infected person within a 14-day time period.

HCF outbreaks should be reported by emailing to CovidOutpatient@ph.lacounty.gov.

HCP should be excluded from work and should self-quarantine at home if they have had a high-risk workplace exposure. 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 (medical-grade surgical/procedure mask or respirator) and twice daily symptom monitoring.

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

• If they had close contact (within 6 feet for a cumulative total of 15 minutes or more over a 24- hour period)
• While not wearing a medical respirator or facemask
• While not wearing eye protection if the case was not wearing a medical facemask or cloth face covering.
• If they had direct unprotected contact with infectious secretions/excretions.
• If they were not properly protected (i.e. not wearing both an N95 respirator and eye protection) while in the same room during an aerosol-generating procedure conducted on the case.

*COVID-19 cases are considered to be infectious from 2 days before their symptoms started until their isolation period ends. Asymptomatic persons with a positive SARS-CoV-2 diagnostic (viral) test are considered to be infectious from 2 days before their test was taken until 10 days after their test was taken.

HCP with high-risk workplace exposures to COVID-19 should be excluded from work and should follow quarantine instructions. 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 may return to work after 10 days if they have never had symptoms. They must continue daily symptom monitoring through day 14. If symptoms occur, they must be immediately excluded from work and told to isolate at home pending clinical evaluation and testing.

Facilities should be aware that break rooms and other common spaces where staff congregate are higher risk settings for transmission between HCP. Facilities should pay particular focus on keeping these areas safe from COVID-19 transmission. See How do we protect staff from COVID-19 exposures to each other?

Exceptions for staffing shortages may be made see; see LAC DPH Guidance for Monitoring Healthcare Personnel.

If a HCP had close contact (within 6 feet for a cumulative total of 15 minutes or more over a 24 hour period) with a confirmed COVID-19 case outside of work, they 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. 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.

Exceptions for critical staffing shortages may be made see LAC DPH Guidance for Monitoring Healthcare Personnel.

While the CDC still recommends a quarantine period of 14 days, they have provided two shorter quarantine options for asymptomatic contacts that reduce the burden of quarantine yet may increase the possibility of spread of the virus: 1) after 10 days without testing and 2) after 7 days with a negative viral test. Persons who are a close contact to a household case have a high incidence of infection. For this reason, HCP who are close contacts to a household case (i.e., the HCP lives with an infected person) should be excluded from work for at least 10 days unless the HCF is experiencing a staffing shortage.

If the HCF is experiencing critical staffing shortage, then HCP who are household close contacts 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.

* Exception-this shortened quarantine should not be used for HCP who work with patients who are severely immunocompromised or who work in dialysis center or skilled nursing facilities unless critical staffing shortages exist.

For more information see LAC DPH Guidance for Monitoring Healthcare Personnel.

Yes. Currently available COVID-19 vaccines have been shown to be effective at preventing symptomatic COVID-19 disease and severe illness. However, evidence is currently lacking on the duration of this protection and the vaccine effectiveness at preventing transmission. There are no changes to current quarantine recommendations for vaccinated HCP.

All non HCP who were close contacts of the infectious patient/visitor while at the HCF should be notified of their exposure and provided with quarantine instructions.

Facilities should ensure that there are systems in place to prevent exposures between patients/visitors including universal source control for all patients, visitors, and staff; limiting the number of patients in waiting rooms/common areas; and arranging seating such that patients/visitors can sit at least 6 feet apart.

When there are possible exposures from an infected patient/visitor to HCP, facilities should inform the exposed HCP and determine if there were any high-risk exposures. See Do HCP need to be quarantined if a patient or a co-worker tests positive?

Any patients or visitors who were close contacts to a HCP with laboratory-confirmed COVID-19 while they were infectious must be notified of their exposure and provided quarantine orders and instructions. This includes those who were close contacts to an infected HCP who was wearing appropriate PPE during the exposure.

All co-workers who were close contacts to the infectious HCP must be informed of their possible exposure and assessed for risk. See Do HCP need to be quarantined if a patient or a co-worker tests positive?

HCPs should wear medical face masks or higher for universal source control at all times while they are in the healthcare facility. Non-medical face coverings do not offer reliable protection in higher risk settings. 

Break rooms and other common spaces where staff congregate are higher risk settings for transmission between HCP. Facilities should pay particular focus on keeping these areas safe from COVID-19 transmission including the following: 

• Ensure 6 feet physical distancing is implemented throughout the facility, particularly in the break/lunchrooms when staff remove their facemasks to eat and drink.
• If feasible, create outdoor break spaces and encourage eating and drinking outdoors and physically distanced from others.
• If only indoor break rooms are available, optimize indoor air quality by opening windows or utilizing filtration systems. Please see: https://www.epa.gov/coronavirus/ventilation-and-coronavirus-covid-19
• Consistently emphasize and encourage use of medical facemasks except when actively drinking and eating. To ensure that masks are worn consistently and correctly, discourage employees from eating or drinking except during their breaks when they are able to safely remove their masks and physically distance from others.
• Place signage in any common spaces (e.g. nursing stations, break rooms) to remind all to maintain physical distancing of more than 6 feet and universal masking.
• Stagger lunch breaks and ask staff to sign-up for specific time slots to minimize the number of staff sharing the breakroom at any one time.
• Remove chairs in break/lunchrooms to limit number of staff gathered in the room at one time
• Ensure hand sanitizers or hand washing stations are readily available at the break rooms.
• Clean and disinfect high touch areas and surfaces in the commonly used congregate staff rooms.

No. While the currently available COVID-19 vaccines have been shown to be effective at preventing symptomatic COVID-19 disease and severe illness, 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, including daily symptom monitoring, source control, and quarantine if exposed.

• Increase the frequency of cleaning and disinfection in the facility, particularly the high-touch areas (e.g., doorknobs, light switches and biometric machines).
• Clean and disinfect surfaces (e.g., exam tables, chairs) used in the care of patients.
• Validate that the product used for surface disinfection is active against SARS-CoV-2, the virus that causes COVID-19. Refer to the EPA approved list on the website: https://www.epa.gov/pesticide-registration/list-n-disinfectants-use-against-sars-cov-2-covid-19
• Follow the manufacturer’s label instructions for proper use and dilution of the disinfectant.

HCP with any signs or symptoms of COVID-19 should be prioritized for SARS-CoV-2 diagnostic testing, even if the symptoms are mild. Asymptomatic HCP who are part of an outbreak investigation, part of facility-wide surveillance testing, or who were close contacts to a case in the community (including household contacts) should be tested. Testing for return to work clearance is not recommended.

Note: viral testing is not recommended for asymptomatic HCP who have had laboratory confirmed COVID-19 within the past 90 days. See Patients with a History of Recent Recovery from COVID-19 for more information.

HCF should have a plan to evaluate HCP with signs and 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 (e.g. non-clinical staff, no known COVID-19 exposure) 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 (e.g. those with direct patient care or with high-risk COVID-19 exposures).

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.

*If recently vaccinated (within the first 2 days after vaccination) , HCF should follow the LAC DPH Post Vaccination Assessment of Symptomatic Healthcare Personnel

Perhaps not. Systemic signs and symptoms, such as fever, fatigue, headache, chills, myalgia, or arthralgia, can occur following COVID-19 vaccination [note: cough, shortness of breath, rhinorrhea, sore throat, or loss of taste or smell are NOT consistent with vaccination]. HCP with postvaccination signs and symptoms could be mistakenly considered infectious and restricted from work unnecessarily. To prevent unnecessary absences, HCF should develop a plan to evaluate HCP with symptoms of possible COVID-19 illness within 2 days after receiving a COVID-19 vaccine dose. The goal of this medical evaluation is to differentiate likely post-vaccine immune reactions from early COVID-19 disease.

HCF should follow the LAC DPH Post Vaccination Assessment of Symptomatic Healthcare Personnel

HCP may return to work when they are no longer infectious. See Return To Work Protocol For HCP With Confirmed COVID-19 in the LAC DPH HCP Monitoring Guidance.

Yes. Many professional societies have developed more specific guidelines for various healthcare settings. Providers and office managers should develop a plan using both general guidance developed by LAC DPH and more specific guidance tailored to the practice type to ensure a safe environment for patient care.

It is imperative for all health care facilities to prepare for the possibility that both influenza and SARS-CoV-2 viruses may be circulating together this fall and winter. Influenza vaccine is recommended as the best method for influenza prevention and should be offered and strongly encouraged for employees. Given that the symptoms of both COVID-19 and flu are hard to distinguish, accurate and prompt influenza diagnosis is important for appropriate clinical decision making and return to work recommendations. We encourage facilities to create a plan for testing and appropriately triaging individuals with flu-like symptoms.

See CDC Influenza Information for Health Professionals https://www.cdc.gov/flu/professionals/index.htm

In alignment with CDC guidelines, HCP who enter the room of a patient with suspected or confirmed SARS-CoV-2 infection should adhere to NIOSH-approved N95 or equivalent or higher-level respirator, gown, gloves, and eye protection. Cal/OSHA Interim guidance recommends N95 respirators be used for the care of confirmed or suspected COVID-19 patients. Initial respirator fit testing is required before an employee uses a respirator, or when an employee changes to a different model, make, or size of respirator.

For more information, please see:

• CDC Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the Coronavirus Disease 2019 (COVID-19) Pandemic https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html
• Cal/OSHA Interim Guidance on COVID-19 for Health Care Facilities (8-6-20) https://dir.ca.gov/dosh/coronavirus/Cal-OSHA-Guidance-for-respirator-shortages.pdf

Visit LAC DPH COVID-19 Vaccine Provider Information Hub. This website hosts local, state, and national resources related to COVID-19 vaccination. As information about the COVID-19 vaccination program is changing rapidly, healthcare providers are encouraged to check this website often for the most up-to date local information.