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By Gary Evans, Medical Writer
As the COVID-19 outbreak in the United States begins to shift from travel-related to community spread, the Centers for Disease Control and Prevention (CDC) has issued guidelines that would allow asymptomatic healthcare workers to still work if they have a “low-risk” exposure to a coronavirus patient.
“Facilities could consider allowing asymptomatic healthcare personnel (HCP) who have had an exposure to a COVID-19 patient to continue to work after consultation with their occupational health program,” the CDC states. “These HCP should still report temperature and absence of symptoms each day prior to starting work. Facilities could have exposed HCP wear a facemask while at work for the 14 days after the exposure event if there is a sufficient supply of facemasks.”
If these workers develop even mild symptoms consistent with COVID-19, they must stop all patient care, notify their supervisor, and leave work, the CDC recommends. The thinking, in part, is to maintain the critically needed healthcare workforce rather than have arbitrary and extensive furloughs.
Examples of low risk include exposure to a COVID-19 patient not wearing any one of these: eye protection, a gown, or gloves. Wearing a surgical mask instead of an N95 respirator while exposed to a coronavirus patient also is categorized as a low risk. Of course, individual circumstances could affect these situations greatly, and the CDC recommendations are non-regulatory and optional.
The guidelines state that the CDC has “removed [the] requirement under ‘self-monitoring with delegated supervision’ for healthcare facilities to actively verify absence of fever and respiratory symptoms when HCP report for work. This is now optional.” The CDC also simplified risk exposure categories based on the most common scenarios involving source control measures, use of personal protective equipment (PPE), and the duration of contact with the patient.
“[Community transmission] means previously recommended actions (e.g., contact tracing and risk assessment of all potentially exposed HCP) are impractical for implementation by healthcare facilities,” the CDC guidelines state. “In the setting of community transmission, all HCP are at some risk for exposure to COVID-19, whether in the workplace or in the community. Facilities should shift emphasis to more routine practices, which include asking HCP to report recognized exposures, regularly monitor themselves for fever and symptoms of respiratory infection, and not report to work when ill.”
Employee health professionals should develop a plan for how they will screen for symptoms and evaluate sick workers. This could include having healthcare workers report absence of fever and symptoms prior to starting work each day.
For more on this story, see the April 2020 issue of Hospital Infection Control & Prevention.