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

AFL 20-17
March 3, 2020

All Facilties

Guidance for Healthcare Facilities on Preparing for Coronavirus Disease 2019 (COVID-19) 


​All Fa​cilties Letter (AFL) Summary 

This AFL provides healthcare facilities new and updated COVID-19 guidance from the Centers for Disease Control and Prevention (CDC), which include: 

  • Interim guidance healthcare facilities should follow to prepare for community transmission of COVID-19
  • Strategies to prevent spread in long-term care (LTC) facilities
  • Use of N95 filtering facepiece respirators (N95s) that have exceeded their manufacturer-designated shelf life​

NOTE: This AFL is no longer in effect and is for historical purposes only​

​​CDC Guidance for Healthcare Facilities

Community transmission has been confirmed in California, although the extent of transmission remains unknown. California healthcare facilities should follow the CDC's Interim Guidance for Healthcare Facilities: Preparing for Community Transmission of COVID-19 in the United States to:

  • Work with your local public health department to understand the impact and spread of the outbreak in your area.
  • Designate staff who will be responsible for caring for suspected or known COVID-19 patients. Ensure they are trained on the infection prevention and control recommendations for COVID-19 and proper use of personal protective equipment.
  • Monitor healthcare workers and ensure maintenance of essential healthcare facility staff and operations:
  • Ensure staff are aware of sick leave policies and are instructed to stay home if they are ill with respiratory symptoms.
  • Be aware of recommended work restrictions and monitoring guidance for staff exposed to COVID-19 patients.
  • Instruct employees to check for any signs of illness before reporting to work each day and notify their supervisor if they become ill; In settings of widespread transmission, consider screening staff for fever or respiratory symptoms before entering the facility.
  • Make contingency plans for increased absenteeism caused by employee illness or illness in employees' family members that would require them to stay home, including extending hours, cross-training current employees, or hiring temporary employees.
  • When possible, manage mildly ill COVID-19 patients at home.

In addition to the general recommendations in the setting of community transmission, CDC provides guidance for specific health care settings including outpatient facilities, acute care inpatient facilities, and long term care facilities (LTC).

Additionally, for LTC facilities, the CDC released Strategies to Prevent the Spread of COVID-19 in Long-Term Care Facilities to provide general information to prevent spread of respiratory infections and  to prepare to care for residents with COVID-19. California LTC facilities should continue to adhere to the CDC Interim Infection Prevention and Control Recommendations for Patients with Confirmed Coronavirus Disease 2019 (COVID-19) or Persons Under Investigation for COVID-19 in Healthcare Settings which recommends standard, contact, and airborne precautions, and use of eye protection.

Use of Expired N95 Respirators

The CDC also provided guidance for the “Release of Stockpiled N95 Filtering Facepiece Respirators Beyond the Manufacturer-Designated Shelf Life: Considerations for the COVID-19 Response." The CDC advised that certain N95 models past manufacturer-designated shelf life can be considered when responding to COVID-19; however, these N95 models should be used only as outlined in the CDC Strategies for Optimizing the Supply of N95 Respirators, and in compliance with State laws and regulations..

The California Division of Occupational Safety and Health (Cal/OSHA) developed and published interim guidance for the efficient use of respirator supplies. Facilities should refer to the Cal/OSHA Interim Guidance on Novel Coronavirus (COVID-19) for Health Care Facilities: Efficient Use of Respirator Supplies to ensure compliance with the aerosol transmissible disease (ATD) standard. For more information on stockpiled N95s, please refer to the joint CDPH-CAL/OSHA Frequently Asked Questions About Use of Stockpiled N95 Filtering Facepiece Respirators for Protection from COVID-19 Beyond the Manufacturer-Designated Shelf Life (PDF).

Program Flexibility for Alternative Spaces

CDPH encourages facilities to submit program flexibility requests to create alternative spaces on their property for screening patients. General acute care hospitals may refer to AFL 18-09 for more information on requesting temporary program flexibility for increased patient accommodations during a disease outbreak. Other healthcare facilities and providers may refer to this AFL guidance in requesting program flexibility for regulations applicable to their facility type.

Long Term Care Patient Transfer/Discharge/Readmits

CDPH asks that any hospital who receives a long term care resident transfer who becomes a PUI or confirmed case for COVID-19, first reach out to their local public health department for coordination before the patient is discharged, if the patient no longer requires hospitalization. 

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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