Skip Navigation LinksAFL-21-08

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EDMUND G. BROWN JR.
Governor

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


AFL 21-08.1
March 5, 2021


TO:
General Acute Care Hospitals (GACHs)
Acute Psychiatric Hospitals (APHs)
Skilled Nursing Facilities (SNFs)

SUBJECT:
Guidance on Quarantine for Health Care Personnel (HCP) Exposed to SARS-CoV-2
(This AFL supersedes AFL 21-08)


All Facilities Letter (AFL) Summary

  • The purpose of this AFL is to provide health care facilities with updated guidance on exposure risk assessment and the duration of quarantine for SARS-CoV-2 exposed HCP working in hospitals and SNFs and SNF residents.
  • This revision includes updated risk assessment and quarantine guidance from the Centers for Disease Control and Prevention (CDC) for HCP working in hospitals and SNFs and SNF residents who have been fully vaccinated against SARS-CoV-2.

Background

The CDC and California Department of Public Health (CDPH) currently recommend a quarantine period of 14 days after Coronavirus Disease 2019 (COVID-19) exposure, based on estimates of the upper bounds of the COVID-19 incubation period; however, a 14-day quarantine may not be feasible in health care settings during critical staffing shortages when there are not enough staff to provide safe patient care. On December 2, 2020, the CDC posted options to reduce quarantine for contacts of persons with SARS-CoV-2 infection and updated its guidance on Strategies to Mitigate Healthcare Personnel Staffing Shortages. Also, on December 14, 2020, CDPH posted CDPH guidance on the duration of quarantine. This AFL is intended to clarify CDPH's December 14th guidance as it applies to HCP.

The CDC updated its COVID-19 vaccination guidance to address quarantine of vaccinated persons on February 10, 2021 and its guidance on health care personnel with potential exposure to SARS-CoV-2 to incorporate these changes on February 16, 2021. This revision to this AFL is intended to clarify updated risk assessment and quarantine guidance for HCP working in hospitals and SNFs and SNF residents who have been fully vaccinated against SARS-CoV-2.

Hospital HCP

Hospitals should continue to use the CDC's risk assessment framework to determine exposure risk for HCP with potential exposure to patients, visitors, and other HCP with confirmed COVID-19 in a health care setting. CDC guidance for assessing travel and community-related exposures should continue to be applied to HCP with potential exposures outside of work (e.g., household,) and among HCP exposed to each other while working in non-patient care areas (e.g., administrative offices). The exposure period begins from two days before the onset of symptoms or, if asymptomatic, two days before test specimen collection for the individual with confirmed COVID-19.

HCP, including fully vaccinated HCP, with higher risk exposure[1] in a health care setting, or identified as close contacts in the community or while working in non-patient care areas, should generally be excluded from work during their quarantine period; however, hospitals may follow CDC staffing shortage mitigation strategies that provide options to reduce quarantine for asymptomatic HCP exposed at work or in the community, including the following CDPH-recommended options:

  • Asymptomatic HCP may discontinue quarantine after Day 10 from the date of last exposure with or without testing.
  • During critical staffing shortages, exposed asymptomatic HCP are not prohibited from returning after Day 7 from the date of last exposure if they have received a negative PCR test result from a specimen collected after Day 5.

Hospitals may also continue to use CDC guidance for staffing shortage mitigation strategies to determine when it could be appropriate to allow asymptomatic HCP with exposure but no known infection to continue to work onsite during their 14-day post-exposure period. 

As an additional strategy for alleviating staffing shortages, hospitals may consider allowing vaccinated health care personnel with a higher risk exposure to someone with suspected or confirmed COVID-19 to continue to work onsite during their post-exposure period if they meet all of the following criteria per updated CDC guidance:

  • The staff are fully vaccinated (i.e., ≥2 weeks following receipt of the second dose in a 2-dose series, or ≥2 weeks following receipt of one dose of a single-dose vaccine).
  • The staff are within 3 months following receipt of the last dose in the series.
  • They remained asymptomatic since the current COVID-19 exposure.

HCP meeting the 3 above criteria would not be required to quarantine outside of work. HCP who do not meet all 3 of the above criteria should continue to follow current quarantine guidance after a higher risk exposure to someone with suspected or confirmed COVID-19.

The CDC notes its COVID-19 vaccination guidance to address quarantine of vaccinated persons, updated February 10, 2021, that, "These quarantine recommendations for vaccinated persons, including the criteria for timing since receipt of the last dose in the vaccination series, will be updated when more data become available and additional COVID-19 vaccines are authorized."

All exposed HCP must continue wearing a surgical mask or respirator for source control within the facility. All HCP must also continue to report temperature and absence of symptoms each day. Health care facilities should understand that shortening the duration of a work restriction might result in additional transmission risks.

SNF HCP and Residents
SNFs should also generally use the CDC's risk assessment framework to determine the risk of exposure and application of work restrictions for HCP with potential exposure to patients, visitors, or other HCP with confirmed COVID-19 in a health care setting. CDC guidance for assessing travel and community-related exposure should be applied to HCP with potential exposures outside of work (e.g., household) and exposures among HCP exposed to each other while working in non-patient care areas (e.g., administrative offices). 

CDPH guidance on the duration of quarantine recommends that SARS-CoV-2 exposed individuals who reside in a high-risk congregate living setting, such as SNF residents, quarantine for 14 days. Due to the unknown vaccine effectiveness in the SNF resident population, vaccinated residents in SNFs should continue to quarantine following an exposure to someone with suspected or confirmed COVID-19.

SNF HCP, including vaccinated HCP, exposed to SARS-CoV-2 that work in a high-risk congregate living setting should also be excluded from work for 14 days in the absence of staffing shortages. During critical staffing shortages, exposed asymptomatic HCP are not prohibited from returning to work after Day 7 from the date of last exposure if they have received a negative PCR test result from a specimen collected after Day 5 after the date of last exposure.

During critical staffing shortages, vaccinated SNF HCP with a higher risk exposure to someone with suspected or confirmed COVID-19 may continue to work onsite during their post-exposure period if they meet all of the following criteria per updated CDC guidance:

  • The staff are fully vaccinated (i.e., ≥2 weeks following receipt of the second dose in a 2-dose series, or ≥2 weeks following receipt of one dose of a single-dose vaccine).
  • The staff are within 3 months following receipt of the last dose in the series.
  • They remained asymptomatic since the current COVID-19 exposure.

HCP meeting the 3 above criteria would not be required to quarantine outside of work. HCP who do not meet all 3 of the above criteria should continue to follow current quarantine guidance after a higher risk exposure to someone with suspected or confirmed COVID-19.

In general, during an outbreak in a SNF, all HCP are considered potentially exposed and may continue working as long as they remain asymptomatic and are serially tested as part of facility-wide outbreak response testing. All potentially exposed HCP must continue wearing a surgical mask or respirator for source control within the facility, and report temperature and absence of symptoms each day.

If you have any questions regarding this AFL, quarantine guidance or work restrictions, please contact CDPH Healthcare-Associated Infections Program via email at HAIProgram@cdph.ca.gov or novelvirus@cdph.ca.gov.  

 

Sincerely,

Original signed by Heidi W. Steinecker

Heidi W. Steinecker
Deputy Director

 

Resources


[1] According to the CDC guidance on health care personnel with potential exposure to SARS-CoV-2, "Higher-risk exposures generally involve exposure of HCP's eyes, nose, or mouth to material potentially containing SARS-CoV-2, particularly if these HCP were present in the room for an aerosol-generating procedure."

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