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EDMUND G. BROWN JR.
Governor

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


AFL 20-38.7
June 16, 2021


TO:
All Facilities

SUBJECT:
Visitor Limitations Guidance
(This AFL supersedes AFL 20-38.6)


All Facilities Letter (AFL) Summary

  • This AFL revision updates and consolidates California Department of Public Health's (CDPH's) visitation guidance into single set of recommendations for all facilities in all counties, considering California is moving Beyond the Blueprint for a Safer Economy framework effective June 15, 2021.
  • This AFL also provides updated visitation guidance based upon CDC's updated healthcare infection prevention and control recommendations in response to COVID-19 vaccination for non-long-term care facilities (e.g., General Acute Care Hospitals, Acute Psychiatric Hospitals).
  • Long-term care (LTC) facilities should continue to refer to AFL 20-22.8 for updated LTC visitation guidance.

On April 27, 2021, CDC released updated healthcare infection prevention and control recommendations in response to COVID-19 vaccination. Given the progress of vaccination and declining COVID-19 incidence in California, CDPH is revising the visitation in non-long-term care facilities (e.g., General Acute Care Hospitals, Acute Psychiatric Hospitals) to further expand opportunities for visitation to support mental health, well-being and recovery of patients. Additionally, CDPH is consolidating this guidance into single set of recommendations for all non-long-term care facilities in all counties, considering California is moving Beyond the Blueprint for a Safer Economy. Facilities should begin preparations to modify their processes to accommodate the visitation changes that will be effective June 22, 2021. Nonetheless, CDPH continues to recommend a cautious and gradual lifting of restrictions while remaining vigilant for breakthrough infections and transmission in facilities through ongoing surveillance and testing.

For purposes of this AFL, the terms "visitor" and "support person" are used interchangeably, as are "patient" and "resident."

The following recommendations will be effective June 22, 2021. Until then, hospitals may follow the recommendations in AFL 20-38.6.

CDPH recommends that hospitals in all counties allow all patients to have up to two visitors from the same household at the same time, provided physical distancing can be accomplished and visitors comply with hospital visitor guidelines.

In addition, CDPH continues to recommend up to two visitors or support persons not necessarily from the same household at the same time, provided physical distancing can be accomplished, for specific patient groups to ensure support for their mental health and well-being:

  • Pediatric Patients
  • Labor and Delivery Patients
  • In addition to the support person(s), CDPH recommends that a doula, if desired by the patient, be permitted to be present if prior arrangements have been made with the hospital and the doula complies with hospital PPE and infection control guidelines.
  • Patients at End-of-Life
  • Patients with Physical, Intellectual, and/or Developmental Disabilities and Patients Cognitive Impairments
  • Surgery Patients
    • CDPH recommends that up to two visitors be permitted until the patient is taken into prep (provided physical distancing can be accomplished), and up to two visitors when the patient is in recovery and preparing for discharge. Visitors may use waiting rooms it they are set up to maintain distancing between individuals and groups, and wear appropriate facial covering at all times in the waiting room.

Visitors do not need to be designated in advance by the patient. Unvaccinated visitors returning from international travel should quarantine and not visit the hospital until quarantine is completed; fully vaccinated visitors, however, do not need to quarantine after travel.

Each visitor, regardless of their vaccination status, should be screened for fever and COVID-19 symptoms; must wear a face covering upon entry and at all times within the facility; must wear other personal protective equipment (PPE) as appropriate while in the patient's room; and must physically distance from healthcare personnel and other patients/residents/visitors that are not part of their group at all times while in the facility. The only exception to face covering requirements and physical distancing is during certain situations in patient rooms, as described below. Facilities should also limit visitor movement in the facility. For example, visitors should not walk around in hallways of the facility and must go directly to and from the patient's room.

Hospitals will not necessarily know the vaccination status of all visitors and patients. However, if hospitals allow any different practices for visitors and patients who are fully vaccinated, they should ask visitors and patients if they are fully vaccinated. If a visitor or patient cannot provide documentation that they are fully vaccinated, the hospital can rely on a visitor or patient stating that they are fully vaccinated for purposes of following this guidance.

Visits between fully vaccinated visitors and fully vaccinated patients may be conducted without face coverings and physical distancing and may include physical contact (e.g., a hug, holding hands) and eating together, while alone in the patient's room (no other patients, visitors, or health care personnel are present).

CDPH supports efforts to ensure that new nurses and other professionals coming into the healthcare workforce are able to obtain necessary clinical experience. CDPH encourages students obtaining their clinical experience be permitted to enter the facility if they meet the CDC guidelines for healthcare workers to maintain the workforce needed during this pandemic. Hospitals may allow volunteers in the facility in compliance with their internal policies.

Additionally, CDPH strongly encourages facilities, including but not limited to skilled nursing facilities, to create ways for residents and patients to have frequent video and phone call visits. If shared devices are used for video calls facilities should ensure appropriate infection control measures are in place. For additional visitation guidance applicable to SNFs, please see AFL 20-22.8 and for guidance applicable to the various kinds of ICF/DD facilities please see AFL 21-14.

If you have any questions about this AFL, please contact your local district office.


Sincerely,

Original signed by Cassie Dunham

Cassie Dunham

Acting Deputy Director




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