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).
All persons who work in healthcare facilities must be vaccinated against COVID-19 (i.e., primary COVID-19 vaccine series plus one booster when eligible) as required by the LA County and the California State Public Health Officers. Additionally, healthcare workers who are eligible are required to receive a booster dose of a COVID-19 vaccine by March 1, 2022. Workers may be exempt from the vaccination requirements based on either a) Religious Beliefs or b) a Qualifying Medical Reason. These vaccination requirements include all workers who provide services or work in outpatient clinics (including behavioral health, surgical, and dental) and dialysis centers. HCP who provide proof of recent COVID-19 infection may defer 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. During the 90-day period after infection with COVID-19, LAC DPH does not recommend any additional COVID-19 viral testing of asymptomatic HCP.
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.
COVID-19 vaccination is very effective at protecting people from severe COVID-19 illness, hospitalization, and death. Vaccinating all staff, including with booster doses, is a central strategy to protect staff and to lower the risk of transmission within the facility. Like all vaccines, COVID-19 vaccines are not 100% effective at preventing infection. HCP who are up to date with their COVID-19 vaccinations may still get infected or have symptomatic COVID-19. For this reason, other protective measures remain important.
HCPs should continue to wear well-fitting 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.
*Face masks may be removed when the HCP is alone in a room and when eating and drinking.
Break rooms and other common spaces where staff congregate are higher risk settings for transmission between HCP, even if they are vaccinated. Facilities should continue to focus on keeping these areas safe from COVID-19 transmission including the following:
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.
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 2. Work Restrictions for Asymptomatic HCP with Exposures (Quarantine). 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. Read the order and accompanying FAQs: Order FAQ
*HCP who previously tested positive for COVID-19 and are asymptomatic should not be retested for 90 days since the date of symptom onset or date of collection of the first positive test. If the staff develop new symptoms consistent with COVID-19 <90 days of the initial positive test, if an alternative etiology cannot be identified, then retesting (preferably with antigen test) can be considered in consultation with facility medical director, infectious disease specialists, or infection control experts.
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, regardless of vaccination status. Symptomatic HCP with compatible symptoms and no clear alternate diagnosis are to isolate at home pending clinical evaluation and testing.
See Return to Work for Symptomatic HCP for more details.
*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
This depends on staffing issues and vaccination status. See Return To Work Protocol For HCP With Confirmed COVID-19.
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.
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:
Additional questions not addressed in this FAQ can be answered by contacting the LAC DPH COVID-19 Outpatient Team at CovidOutpatient@ph.lacounty.gov.
LAC DPH COVID-19
Centers for Disease Control and Prevention
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