HCP1 working in hospitals remain at potential risk for SARS-CoV-2 exposures both in the community and in their workplace. Infected HCP can transmit to other HCP (through close contact in break rooms and other common areas) as well as their patients. In December 2020, the California Department of Public Health (CDPH) recommended routine SARS-CoV-2 diagnostic screening testing of hospital HCP to aid in early identification and work exclusion of infected HCP, reduce transmission risk to other HCP and patients, and prevent hospital outbreaks. Subsequently, State Public Health Officer Orders issued on August 5, 2021, and amended on December 22, 2021, and February 22, 2022, required twice weekly routine diagnostic screening testing for COVID-19 unvaccinated exempt hospital HCP and booster-eligible HCP who have not yet received their booster. Since that time, however, COVID-19 vaccination coverage among HCP increased to high levels and proportion of unvaccinated HCP is low. In addition, the Omicron subvariants have shown immune escape and increased transmissibility, and while unvaccinated individuals still have higher risk of infection, previously infected, vaccinated, and boosted persons have also been infected. Consequently, mandated testing of the small number of unvaccinated workers is not effectively preventing disease transmission as it did with the original COVID-19 virus and prior variants earlier in the pandemic.
Accordingly, on September 13, 2022, the California Department of Public Health amended the Public Health Order – Health Care Worker Vaccine Requirement to no longer requiring routine diagnostic COVID-19 testing for unvaccinated exempt or booster-eligible HCP. These amendments were made to reflect recent CDC recommendations, the current science of the Omicron subvariants, the increases in community immunity from vaccination and infection, and increases in vaccine coverage of our healthcare workforce.
Updated Routine Diagnostic Screening Testing of Hospital HCP
Pursuant to the Public Health Order – Health Care Worker Vaccine Requirement issued September 13, 2022, HCP are no longer required to undergo the routine SARS CoV-2 diagnostic screening testing; however, facilities should have the ability to ramp up testing at their worksite in the event of outbreaks or if it is required again at a future date. Facilities should also continue to offer testing for employees in accordance with recommendations from CDPH. HCP may consider routine diagnostic screening testing if they have underlying immunocompromising conditions to facilitate prompt initiation of antiviral therapy given the greater risks such individuals face if they contract COVID-19.
Diagnostic Testing for Symptomatic HCP
HCP with signs or symptoms consistent with COVID-19 should be tested immediately, regardless of their vaccination status. If antigen testing is used and the first test is negative, the symptomatic HCP should be tested again with either an antigen or molecular test 48 hours after the first negative test, for a total of at least two tests. HCP with a prior positive viral test who develop new symptoms consistent with COVID-19 should be tested if it is more than 30 days after the date of onset of the prior infection; if symptoms develop within 30-90 days of a prior infection, an antigen test should be used.
Post-Exposure and Response Testing of HCP
Testing should be performed for all HCP regardless of their vaccination status following higher-risk exposures to SARS-CoV-2. Contact tracing and testing of exposed individuals also should be performed in response to a cluster of cases meeting the outbreak investigation threshold for hospitals in AFL 20-75.1. All HCP and patients identified with higher-risk exposure through contact tracing, regardless of vaccination status, should be tested promptly (but not earlier than 24 hours after the exposure) and, if negative, again at 3 days and if negative, again at 5 days after the exposure. Post-exposure testing is not generally recommended for HCP who have had SARS-CoV-2 infection in the last 30 days if they remain asymptomatic. Hospitals should work with their local health department to guide response testing. Refer to AFL 21-08.9 for further guidance about management of HCP who have higher-risk exposures.
Testing for Newly Admitted, Newly Symptomatic and Exposed Patients
Hospitals should consider testing asymptomatic patients prior to or upon admission or procedure wherever these results might be useful to inform the type of infection control precautions used (e.g., room assignment/cohorting, or personal protective equipment used). Hospitals should also continue to monitor all patients for the development of COVID-19 symptoms, and promptly test any newly symptomatic patients and patients who are exposed to a suspected or confirmed case during their hospital stay, regardless of their vaccination status.
Plans for Use and Follow-up of Test Results
CDPH recommends that GACHs that implement HCP testing programs include policies and procedures addressing the use of test results, including:
- How results will be explained to HCP
- How to communicate information about any positive cases of HCP in the facility to responsible parties
- How results (positive or negative) will be tracked for HCP at the facility and methods for reporting results to CDPH and the LHD (facilities may refer to AFL 20-75.1 Coronavirus Disease 2019 (COVID-19) Outbreak Investigation and Reporting Thresholds for additional guidance on reporting testing results in response to an outbreak investigation)
- How results will be used to guide implementation of infection control measures, including plans for notification and testing of other HCP and patients exposed to positive HCP
- A procedure for addressing HCP that decline or are unable to be tested
- Plans to address potential staffing shortages for positive HCP who are excluded from work
Procedures for the Duration of Work Exclusion of HCP Who Test Positive
Hospitals should refer to AFL 21-08.9 for guidance about work exclusion and return to work for HCP who test positive for COVID-19.
Hospitals should revise their General Acute Care Hospital COVID-19 Mitigation Testing Plan (PDF) to reflect any changes in practice and have it available for review for CDPH upon request.
GACHs must continue to observe all other infection prevention and control interventions, including monitoring all HCP and patients for signs and symptoms of COVID-19, masking by HCP and patients for source control, arrange HCP common areas (e.g., breakrooms) to avoid crowding, use of recommended personal protective equipment (PPE), and environmental cleaning and disinfection. When testing is performed, a negative test only indicates an individual did not have detectable infection at the time of testing; individuals might have SARS-CoV-2 infection that is still in the incubation period or could have ongoing or future exposures that lead to infection.
Hospitals should continue to implement strategies to increase, maintain, and track vaccination coverage among HCP, including verifying vaccination status of new hires, and offering education, listening sessions, counseling, and vaccination at every opportunity, even to those HCP who have previously refused.
GACHs may submit any questions about this AFL or about infection prevention and control of COVID-19 to the CDPH Healthcare-Associated Infections Program via email at HAIProgram@cdph.ca.gov.
If you have any questions about state testing prioritization plans, please contact the Testing Taskforce at firstname.lastname@example.org.
Original signed by Cassie Dunham
1Healthcare Personnel (HCP) refers to all paid and unpaid persons serving in healthcare settings who have the potential for direct or indirect exposure to patients or infectious materials, including body substances (e.g., blood, tissue, and specific body fluids); contaminated medical supplies, devices, and equipment; contaminated environmental surfaces; or contaminated air. HCP include, but are not limited to nurses, nursing assistants, home healthcare personnel, physicians, technicians, therapists, phlebotomists, pharmacists, students and trainees, contractual staff not employed by the healthcare facility, and persons not directly involved in patient care, but who could be exposed to infectious agents that can be transmitted in the healthcare setting (e.g., clerical, dietary, environmental services, laundry, security, engineering and facilities management, administrative, billing, and volunteer personnel).