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State of California—Health and Human Services Agency
California Department of Public Health

AFL 20-15.1
April 9, 2020

All Facilities

Infection Control Recommendations for Facilities with Suspect Coronavirus 2019 (COVID-19) Patients
(This AFL supersedes AFL 20-15)


All Facilities Letter (AFL) Summary

This AFL notifies healthcare facilities of the California Department of Public Health's (CDPH's) infection control recommendations for outpatient healthcare facilities with suspect COVID-19 patients.  

NOTE: This AFL is no longer in effect and is for historical purposes only

CDPH is closely working with the Centers for Disease Control and Prevention (CDC), local governments, and health care providers across the state to respond to the outbreak of COVID-19. To prevent infections from spreading during healthcare delivery, CDPH has developed infection control recommendations for outpatient healthcare facilities with suspect COVID-19 patients.

Suspect COVID-19 patients are those with fever or signs/symptoms of respiratory illness and a history in the prior 14 days of contact with a laboratory-confirmed COVID-19 case or travel to an affected country or area as per the latest CDC recommendations. If your facility suspects COVID-19 infection, please refer to the CDPH Outpatient Healthcare Facility Infection Control Recommendations for Suspect COVID-19 Patients (PDF).

For direct care healthcare workers and/or social services workers providing care with potential exposure to COVID-19, refer to the CDC's Interim U.S Guidance for Risk Assessment and Work Restrictions for Healthcare Personnel with Potential Exposure to COVID-19. This interim guidance is intended to assist with assessment of risk, monitoring, and work restriction decisions for healthcare personnel with potential exposure to COVID-19. Employers of healthcare and social services workers should follow Centers for Disease Control and Prevention (CDC) guidance and Cal/OSHA regulations for employee respiratory protection when providing direct patient care. This includes, if available, use of a NIOSH-certified respirator at least as protective as an N95 filtering facepiece respirator for routine care of suspected or confirmed COVID patients and a powered air-purifying respirator (PAPR) for high hazard or aerosol-generating procedures on these patients. Cal/OSHA and CDC have issued specific guidance and conditions on using temporary alternatives to respirators for routine care during periods of extreme respirator shortages such as the one we are currently experiencing. (See Note below on use of non-certified KN95 respirators).

*Note on KN95 Respirators: Cal/OSHA's guidance also expands the types of respirators that can be used to comply with Cal/OSHA standards during this emergency. KN95 respirators from China are not currently certified for use as respirators by NIOSH, but may be an acceptable alternative if NIOSH-certified respirators are not available due to the supply shortage and prioritization of approved respirators for direct care healthcare workers and social services workers providing direct care to COVID-19 positive person.

On April 3, 2020, certain models of KN95 respirators were recently approved for import by the Food and Drug Administration, and for use in health care settings under an Emergency Use Authorization if certain criteria are met. NIOSH-certified respirators should still be prioritized if available. As with N95s, KN95s should be fit tested if worn to comply with a Cal/OSHA respiratory protection standard that requires fit-testing.

There have been reports of counterfeit respirators entering the U.S. market, including respirators labeled as KN95s. Before use, any KN95 respirator should be verified for authenticity, if possible. Employer and employees should also inspect them for damage, including for visible holes when held up to the light, defects that limit a close seal to the face, appearance that they are counterfeit, or some other obvious problem.

If you have any questions regarding the infection prevention and control of COVID-19, please contact the CDPH Healthcare-Associated Infections (HAI) Program at



Original signed by Heidi W. Steinecker

Heidi W. Steinecker
Deputy Director



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