Risk Assessment and Quarantine for Healthcare Workers

Risk determination for COVID-19 in the healthcare setting is different from that of the general public.  The following recommendations are specifically aimed at healthcare workers.  If you are a member of the general public see: (whatever the URL will be for public risk determination).  The tables below are from the CDC with some formatting changes and comments only.

Taken from the CDC Interim U.S. Guidance for Risk Assessment and Public Health Management of Healthcare Personnel with Potential Exposure in a Healthcare Setting to Patients with Coronavirus Disease (COVID-19) (last modified 13 March 13, 2020).

  1. The first step in determining risk and need for quarantine/isolation is determining the level and mode of exposure to the virus (Table 1).
  2. Once risk is determined, look at Table 2, Recommended Monitoring based on risk of COVID-19 exposure, for appropriate isolation/quarantine precautions. 

Table 1:  Type of COVID-19 Exposure

Epidemiologic risk factors

Exposure category

Recommended Monitoring for COVID-19 (until 14 days after last potential exposure)

Work Restrictions for Asymptomatic HCP

Prolonged close contact with a COVID-19 patient who was wearing a facemask (i.e., source control)

HCP PPE: None

Medium

Active

Exclude from work for 14 days after last exposure

HCP PPE: Not wearing a facemask or respirator

Medium

Active

Exclude from work for 14 days after last exposure

HCP PPE: Not wearing eye protection

Low

Self with delegated supervision

None

HCP PPE: Not wearing gown or glovesa

Low

Self with delegated supervision

None

HCP PPE: Wearing all recommended PPE (except wearing a facemask instead of a respirator)

Low

Self with delegated supervision

None

Prolonged close contact with a COVID-19 patient who was not wearing a facemask (i.e., no source control)

HCP PPE: None

High

Active

Exclude from work for 14 days after last exposure

HCP PPE: Not wearing a facemask or respirator

High

Active

Exclude from work for 14 days after last exposure

HCP PPE: Not wearing eye protectionb

Medium

Active

Exclude from work for 14 days after last exposure

HCP PPE: Not wearing gown or glovesa,b

Low

Self with delegated supervision

None

HCP PPE: Wearing all recommended PPE (except wearing a facemask instead of a respirator)b

Low

Self with delegated supervision

None

HCP=healthcare personnel; PPE=personal protective equipment

aThe risk category for these rows would be elevated by one level if HCP had extensive body contact with the patients (e.g., rolling the patient).

bThe risk category for these rows would be elevated by one level if HCP performed or were present for a procedure likely to generate higher concentrations of respiratory secretions or aerosols (e.g., cardiopulmonary resuscitation, intubation, extubation, bronchoscopy, nebulizer therapy, sputum induction). For example, HCP who were wearing a gown, gloves, eye protection and a facemask (instead of a respirator) during an aerosol-generating procedure would be considered to have a medium-risk exposure.

Table 2: Recommendations for Monitoring Based on COVID-19 Exposure Risk

A healthcare provider in any of the risk exposure categories who develop signs or symptoms compatible with COVID-19 must contact their established point of contact (public health authorities or their facility’s occupational health program) for medical evaluation prior to returning to work

High- and Medium-Risk Exposure Category

HCP in the high- or medium-risk category should undergo active monitoring, including restriction from work in any healthcare setting until 14 days after their last exposure. If they develop any fever (measured temperature >100.0oF or subjective fever) OR respiratory symptoms consistent with COVID-19 (e.g., cough, shortness of breath, sore throat)* they should immediately self-isolate (separate themselves from others) and notify their local or state public health authority and healthcare facility promptly so that they can coordinate consultation and referral to a healthcare provider for further evaluation.

Low-Risk Exposure Category

HCP in the low-risk category should perform self-monitoring with delegated supervision until 14 days after the last potential exposure.  Asymptomatic HCP in this category are not restricted from work.  They should check their temperature twice daily and remain alert for respiratory symptoms consistent with COVID-19 (e.g., cough, shortness of breath, sore throat)*. They should ensure they are afebrile and asymptomatic before leaving home and reporting for work. If they do not have fever or respiratory symptoms they may report to work.  If they develop fever (measured temperature > 100.0 oF or subjective fever) OR respiratory symptoms they should immediately self-isolate (separate themselves from others) and notify their local or state public health authority or healthcare facility promptly so that they can coordinate consultation and referral to a healthcare provider for further evaluation.On days HCP are scheduled to work, healthcare facilities could consider measuring  temperature and assessing symptoms prior to starting work.  Alternatively, facilities could consider having HCP report temperature and symptoms to occupational health prior to starting work.  Modes of communication may include telephone calls or any electronic or internet-based means of communication.

HCP who Adhere to All Recommended Infection Prevention and Control Practices

Proper adherence to currently recommended infection control practices, including all recommended PPE, should protect HCP having prolonged close contact with patients infected with COVID-19.  However, to account for any inconsistencies in use or adherence that could result in unrecognized exposures, HCP should still perform self-monitoring with delegated supervision as described under the low-risk exposure category.

No Identifiable Risk Exposure Category

HCP in the no identifiable risk category do not require monitoring or restriction from work.

Community or travel-associated exposures

HCP with potential exposures to COVID-19 in community settings, should have their exposure risk assessed according to CDC guidance.  HCP should inform their facility’s occupational health program that they have had a community or travel-associated exposure.  HCP who have a community or travel-associated exposure should undergo monitoring as defined by that guidance.  Those who fall into the high- or medium- risk category described there should be excluded from work in a healthcare setting until 14 days after their exposure. HCP who develop signs or symptoms compatible with COVID-19 should contact their established point of contact (public health authorities or their facility’s occupational health program) for medical evaluation prior to returning to work.

 

 

 

No comments yet.