Guidance on Quarantine for Health Care Personnel (HCP) Exposed to SARS-CoV-2

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AFL 21-08.2 From the California Department of Public Health

March 23, 2021

TO: General Acute Care Hospitals (GACHs)
Acute Psychiatric Hospitals (APHs)
Skilled Nursing Facilities (SNFs)

SUBJECT: Guidance on Quarantine for Health Care Personnel (HCP) Exposed to SARS-CoV-2
(This AFL supersedes AFL 21-08.1)

All Facilities Letter (AFL) Summary

  • The purpose of this AFL is to provide health care facilities with updated guidance on exposure risk assessment and the duration of quarantine for SARS-CoV-2 exposed HCP working in hospitals and SNFs and SNF residents.
  • This revision includes updated risk assessment and quarantine guidance from the Centers for Disease Control and Prevention (CDC) for HCP working in hospitals and SNFs and SNF residents who have been fully vaccinated against SARS-CoV-2.

Background
The CDC and California Department of Public Health (CDPH) currently recommend a quarantine period of 14 days after Coronavirus Disease 2019 (COVID-19) exposure, based on estimates of the upper bounds of the COVID-19 incubation period; however, a 14-day quarantine for unvaccinated health care personnel may not be feasible in health care settings during critical staffing shortages when there are not enough staff to provide safe patient care. It is also not generally recommended for health care personnel who are vaccinated per the March 10, 2021 Centers for Disease Control and Prevention (CDC) guidance on infection control after vaccination.

On December 2, 2020, the CDC posted options to reduce quarantine for contacts of persons with SARS-CoV-2 infection and updated its guidance on Strategies to Mitigate Healthcare Personnel Staffing Shortages. Also, on December 14, 2020, CDPH posted CDPH guidance on the duration of quarantine. This AFL is intended to clarify CDPH’s December 14th guidance as it applies to HCP.

The CDC updated its quarantine guidance to address vaccinated persons on February 10, 2021, and again on March 10, 2021. This revision is intended to clarify current quarantine and work exclusion guidance for HCP working in hospitals and SNFs, and quarantine guidance for SNF residents who have been fully vaccinated against SARS-CoV-2.

Hospital HCP
Hospitals should continue to use the CDC’s risk assessment framework to determine exposure risk for HCP with potential exposure to patients, visitors, and other HCP with confirmed COVID-19 in a health care setting. CDC guidance for assessing travel and community-related exposures should continue to be applied to HCP with potential exposures outside of work (e.g., household,) and among HCP exposed to each other while working in non-patient care areas (e.g., administrative offices). The exposure period begins from two days before the onset of symptoms or, if asymptomatic, two days before test specimen collection for the individual with confirmed COVID-19.
HCP who are not fully vaccinated against SARS-CoV-2, with higher risk exposure in a health care setting, or identified as close contacts in the community or while working in non-patient care areas, should generally be excluded from work during their quarantine period; however, hospitals may follow CDC staffing shortage mitigation strategies that provide options to reduce quarantine for asymptomatic unvaccinated HCP exposed at work or in the community, including the following CDPH-recommended options:

  • Asymptomatic unvaccinated HCP may discontinue quarantine after Day 10 from the date of last exposure with or without testing.
  • During critical staffing shortages, asymptomatic unvaccinated HCP are not prohibited from returning after Day 7 from the date of last exposure if they have received a negative PCR test result from a specimen collected after Day 5.

Hospitals may also continue to use CDC guidance for staffing shortage mitigation strategies to determine when it could be appropriate to allow asymptomatic unvaccinated HCP with exposure but no known infection to continue to work onsite during their 14-day post-exposure period.  Health care facilities should understand that shortening the duration of a work restriction might result in additional transmission risks.

Fully vaccinated HCP (i.e., ≥2 weeks following receipt of the second dose in a 2-dose series, or ≥2 weeks following receipt of one dose of a single-dose vaccine) with higher-risk exposures who are asymptomatic do not need to be restricted from work for 14 days following their exposure. Work restrictions for fully vaccinated HCP populations with higher-risk exposures should still be considered for HCP who have underlying immunocompromising conditions (e.g., organ transplantation, cancer treatment), which might impact level of protection provided by the COVID-19 vaccine, and for fully vaccinated HCP who have traveled (excluding essential work related travel) when quarantine and work restrictions would apply to any traveler.

All HCP must continue wearing a surgical mask or respirator for source control within the facility. All HCP must also continue to report temperature and absence of symptoms each day.

SNF HCP and Residents
SNFs should also generally use the CDC’s risk assessment framework to determine the risk of exposure for HCP with potential exposure to patients, visitors, or other HCP with confirmed COVID-19 in a health care setting. CDC guidance for assessing travel and community-related exposure should be applied to HCP with potential exposures outside of work (e.g., household) and exposures among HCP exposed to each other while working in non-patient care areas (e.g., administrative offices). 

CDPH guidance on quarantine recommends that SARS-CoV-2 exposed individuals who reside in a high-risk congregate living setting, such as SNF residents, quarantine for 14 days. Due to the unknown vaccine effectiveness in the SNF resident population, vaccinated residents in SNFs should continue to quarantine following an exposure to someone with suspected or confirmed COVID-19. Quarantine is no longer required for residents who are being admitted to a post-acute care facility if they are fully vaccinated and have not had prolonged close contact with someone with SARS-CoV-2 infection in the prior 14 days; local health departments may continue to recommend quarantine for newly admitted residents from a hospital where there is known SARS-CoV-2 transmission. Fully vaccinated SNF residents who leave the facility for non-essential purposes (e.g., to go out to a restaurant or visit family in their home) do not need to quarantine upon return.

SNF HCP who are not fully vaccinated against SARS-CoV-2, with higher risk exposure to SARS-CoV-2 or identified as close contacts in the community should be excluded from work for 14 days in the absence of staffing shortages. During critical staffing shortages, asymptomatic unvaccinated SNF HCP are not prohibited from returning to work after Day 7 from the date of last exposure if they have received a negative PCR test result from a specimen collected after Day 5 after the date of last exposure.

Fully vaccinated SNF HCP (i.e., ≥2 weeks following receipt of the second dose in a 2-dose series, or ≥2 weeks following receipt of one dose of a single-dose vaccine) with higher-risk exposures who are asymptomatic do not need to be restricted from work for 14 days following their exposure. Work restrictions for fully vaccinated HCP populations with higher-risk exposures should still be considered for HCP who have underlying immunocompromising conditions (e.g., organ transplantation, cancer treatment), which might impact level of protection provided by the COVID-19 vaccine, and for fully vaccinated HCP who have traveled (excluding essential work related travel) when quarantine and work restrictions would apply to any traveler.

In general, during an outbreak in a SNF, all HCP are considered potentially exposed and may continue working regardless of their vaccination status as long as they remain asymptomatic and are serially tested as part of facility-wide outbreak response testing. All HCP must continue wearing a surgical mask or respirator for source control within the facility, and report temperature and absence of symptoms each day.

These recommendations will be updated as additional information becomes available, including regarding the ability of currently authorized vaccines to protect against infection with novel variants and the effectiveness of additional authorized vaccines. This could result in additional circumstances when work restrictions for fully vaccinated HCP are recommended.

If you have any questions regarding this AFL, quarantine guidance or work restrictions, please contact CDPH Healthcare-Associated Infections Program via email at HAIProgram@cdph.ca.gov or novelvirus@cdph.ca.gov.

Sincerely,

Original signed by Heidi W. Steinecker

Heidi W. Steinecker

Deputy Director

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