12/24/2021
CDC revises return to work guidance, expands staffing mitigation strategies
On December 23, the Centers for Disease Control & Prevention (CDC) released revisions to their Interim Guidance for Managing Healthcare Personnel with SARS-CoV-2 Infection or Exposure to SARS-CoV-2 and Strategies to Mitigate Healthcare Personnel (HCP) Staffing Shortages, incorporating new guidance for healthcare personnel who have received boosters and adjusting guidance for staffing mitigation strategies given the surge of cases due to the Omicron variant.
The complete description of conventional strategies for Return to Work is available in Interim Guidance for Managing Healthcare Personnel with SARS-CoV-2 Infection or Exposure to SARS-CoV-2. Strategies to Mitigate Healthcare Personnel Staffing Shortages details the range of options available to ensure safe staffing levels during shortages. Like before, the mitigation strategies are intended to be used sequentially, and members should document efforts as they work to fulfill staffing needs in each level: conventional, then contingency, and finally crisis.
Members should familiarize themselves with both CDC documents and may want to revise their emergency staffing plans to reflect the updated guidance. Please see below for highlights of the major changes to the revised CDC guidance.
Revised Return to Work Guidance for HCP who test positive for COVID-19 (regardless of vaccination status):
- Conventional Strategy:
- 7 days after symptoms first appeared or after positive test if asymptomatic so long as have a negative test within 48 hours of returning to work and are asymptomatic or mildly symptomatic with improving symptoms (no fever for 24 hours without medicine and improved symptoms), OR
- 10 days after symptoms first appeared or after first positive test if did not take an additional test on day 5-7 or tested positive on day 5-7 so long as asymptomatic or mildly symptomatic with improving symptoms (no fever for 24 hours without medicine and improved symptoms).
- Note: HCP who experience severe symptoms or who are moderately to severely immunocompromised should continue to wait generally 20 days after symptoms first appear before returning to work.
- Contingency Strategy: 5 days after symptoms first appeared (day 0) or after positive test if asymptomatic so long as asymptomatic or mildly symptomatic with improving symptoms (no fever for 24 hours without medicine and improved symptoms). Providers may choose to confirm resolution of the infection with a negative antigen test but are not required to do so.
- Crisis Strategy: As a last resort, no work restrictions with prioritization of asymptomatic then mildly symptomatic with improving symptoms (no fever for 24 hours without medicine and improved symptoms). If utilizing this strategy, considerations for determining which HCPs return to work include:
- The type of HCP shortages that need to be addressed.
- Where individual HCP are in the course of their illness (e.g., viral shedding is likely to be higher earlier in the course of illness).
- The types of symptoms they are experiencing (e.g., persistent fever, cough).
- Their degree of interaction with patients and other HCP in the facility. For example, are they working in telemedicine services, providing direct patient care, or working in a satellite unit away from patients?
- The type of patients they care for (e.g., consider patient care only with patients known or suspected to have SARS-CoV-2 infection rather than immunocompromised patients).
- HCP must be well enough and willing to work.
Recall that if HCP are permitted to return to work before meeting all conventional Return to Work Criteria, they should still adhere to the recommendations described below:
- Patients (if tolerated) should wear well-fitting source control while interacting with these HCP.
- HCP should be reminded that in addition to potentially exposing patients, they could also expose their co-workers.
- A respirator or well-fitting facemask should be worn continuously even when they are in non-patient care areas such as breakrooms.
- They should practice physical distancing from coworkers at all times.
- If they must remove their respirator or well-fitting facemask, for example, in order to eat or drink, they should separate themselves from others.
- They should self-monitor for symptoms and seek re-evaluation from occupational health if symptoms recur or worsen.
Revised Return to Work Guidance for HCPs Exposed to COVID-19
Lower Risk Exposure: No need for quarantine regardless of vaccination status, but HCP should follow all recommended infection prevention and control practices and immediately isolate and test if they develop symptoms.
Higher Risk Exposure: If HCP have received booster as recommended by the CDC:
- Conventional: No work restriction unless moderately to severely immunocompromised but must test 24 hours after exposure and again in 5-7 days if tested negative initially. Can use Antigen or NAAT test, but HCP should follow all recommended infection prevention and control practices and immediately isolate and test if symptoms develop.
- Contingency: No work restriction.
- Crisis: No work restriction.
For all other HCPs not current with boosters recommended by CDC (those who have received primary series and those unvaccinated—even if have had infection within the last 90 days):
- Conventional:
- Option 1: Can return to work following day 7 after the exposure (day 0) if a viral test is negative within 48 hours of return to work and no symptoms have developed; OR
- Option 2: Can return to work following day 10 after the exposure (day 0) if no symptoms have developed. Could choose to also test within 48 hours of return with this option but residual risk is low after 10 days.
- Contingency: No work restriction, but HCP should be tested with Antigen or NAAT 1 day after the exposure (day 0) and, if negative, again 2, 3, and 5-7 days after the exposure. If testing supplies are limited, testing should be prioritized for 1-2 days after the exposure and, if negative, 5-7 days after exposure. While working these HCPs should:
- Report temperature and absence of symptoms each day before starting work.
- Use a respirator or well-fitting facemask at all times in the facility.
- Either not report to work, or stop working and notify their supervisor prior to leaving work if they develop even mild symptoms. These individuals should be prioritized for testing.
- If they test positive with SARS-CoV-2, they should ideally be excluded from work until they meet all Return to Work Criteria. HCP with suspected SARS-CoV-2 infection should be prioritized for testing, as testing results will impact when they may return to work and for which patients they might be permitted to provide care.
- Crisis: No work restriction and no testing, but while working, these HCPs should:
- Report temperature and absence of symptoms each day before starting work.
- Use a respirator or well-fitting facemask at all times in the facility.
- Either not report to work, or stop working and notify their supervisor prior to leaving work if they develop even mild symptoms. These individuals should be prioritized for testing.
Recall that a HCP who have had prolonged close contact with someone with SARS-CoV-2 in the community (e.g., household contacts) should be managed as described for higher-risk occupational exposures above.
As a reminder, on Thursday LeadingAge Ohio alerted members to critical staffing shortages in some areas of Ohio. If your organization has exhausted all options, please reach out directly to Kathryn Brod at (847) 644-3911 who will directly reach out to the Administration for support. For questions on this update or other issues related to COVID-19, please email LeadingAge Ohio at COVID19@leadingageohio.org.