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).

All persons who work in healthcare facilities must be vaccinated against COVID-19 as required by the LA County and the California State Public Health Officers. Workers should have received 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. These vaccination requirements include all workers who provide services or work in outpatient clinics (including behavioral health, surgical, and dental) and dialysis centers.

• LA County Order and FAQs
• CA State Order

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.

Fully vaccinated HCP do not need to be restricted from work following their exposure as long as they are asymptomatic, but post-exposure testing is recommended. They must continue to follow all current infection prevention and control recommendations including source control, daily symptom monitoring, and testing as outlined in the LAC DPH Infection Prevention Guidance for Healthcare Personnel.

HCP who are not fully vaccinated who have had a high-risk workplace exposure should be excluded from work and must quarantine. They should be instructed to immediately contact their established point of contact (e.g., occupational health program) if they develop symptoms of COVID-19.

They may return to work after 10 days have passed from the date of last exposure, as long as they did not develop symptoms of COVID-19. During critical staffing shortages, they are permitted to return to work after 7 days have passed from the date of last exposure IF they have a negative molecular test result collected on or after day 5, as long as they have remained asymptomatic. 

HCP who are fully vaccinated who have had a high-risk workplace exposure and HCP after a lower risk workplace exposure do not need to quarantine or be restricted from work, as long as they are asymptomatic. Post-exposure testing 5-7 days after exposure is recommended after high-risk exposures, regardless of vaccination status. They should continue to follow all current infection prevention and control recommendations including source control, daily monitoring, and testing as outlined in the LAC DPH Infection Prevention Guidance for Healthcare Personnel.

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 mask.
• 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.

Yes, if they are not fully vaccinated. HCP who are not fully vaccinated who are a close contact with a COVID-19 case outside of work must quarantine. They must notify the HCF of their exposure and be restricted from work.

They may return to work after 10 days have passed from the date of last exposure, as long as they did not develop symptoms of COVID-19. During critical staffing shortages, they are permitted to return to work after 7 days have passed from the date of last exposure IF they have a negative molecular test result collected on or after day 5, as long as they have remained asymptomatic. 

HCP who are fully vaccinated do not need to quarantine and do not need to be restricted from work. However, fully vaccinated HCP should monitor their health, continue using source control, and be tested 5-7 days after 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 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.

*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.

**This is regardless of use of face masks of the case or contact.

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?

COVID-19 vaccination is highly effective at preventing COVID-19 disease and severe illness. Vaccinating all staff is a central strategy to protect staff from exposures to each other and to lower the risk of transmission within the facility. Despite this, breakthrough infections do occur, especially with some of the emerging more infectious variants. Additional prevention measures will continue to be necessary for all staff, regardless of vaccination status. 

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: 

• Ensure 6 feet physical distancing between staff is implemented throughout the facility, particularly in the break/lunchrooms when staff remove their facemasks to eat and drink.
• Placing tables eight feet apart, where feasible, will allow for six feet of physical distancing between individuals seated at neighboring tables.
• If feasible, create outdoor break spaces and encourage eating and drinking outdoors and physically distanced from others.
• If indoor break rooms are used, 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 break room 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.

• Routinely clean and disinfect high-touch areas (e.g., doorknobs, light switches, and biometric machines) in facility.
• 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.

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 community close-contact exposure to SARS-CoV-2, regardless of vaccination status. Testing is recommended 5-7 days after last exposure to the confirmed case. 

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 

Notes:

• Testing COVID-19 cases for return-to-work clearance is not recommended unless the worker is severely immunocompromised.
• 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, 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

HCP may return to work when they are no longer infectious. 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:

• 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 for Protecting Hospital Workers From Exposure to COVID-19 https://www.dir.ca.gov/dosh/coronavirus/COVID-19-Interim-Guide-for-Hospital-Workers.html