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CDC Updates Return to Work Guidance

Last week the Centers for Disease Prevention and Control (CDC) announced updates to their guidance on Managing Health Care Personnel with COVID-19 Infection or Exposure. This new guidance provides a shortened return to work criteria for both infections and exposure that incorporates a testing strategy in some circumstances.
 
The following guidance should continue to be used to determine duration of isolation and quarantine for patients and residents.   
The new criteria are as follows:

Return to Work After COVID-19 Infection
The CDC now indicates that health care workers who have tested positive for COVID-19 can return to work depending on the severity of their COVID-19 infection, but should monitor for symptoms after returning to work and seek testing, should symptoms develop. Also, Antigen testing is preferred for symptomatic health care personnel (HCP) and for asymptomatic HCP who have recovered from COVID-19 infection in the prior 90 days.

For contingency and crises staffing situations shorter time frames can be used (see CDC site for contingency and crisis staffing).

For conventional staffing, HCP who were asymptomatic throughout their infection and are not moderately to severely immunocompromised:
  • Return to work after 7 days with a negative antigen or PCR test within 48 hours prior to returning to work.
  • Or 10 days if testing is not performed or a positive test at day 5-7 since the date of their first positive viral test.
HCP with mild to moderate illness who are not moderately to severely immunocompromised:
  • Return to work after 7 days with a negative antigen or PCR test within 48 hours prior to returning to work
  • Or 10 days if testing is not performed or if a positive test at day 5-7 since symptoms first appeared; and
    • At least 24 hours have passed since last fever without the use of fever-reducing medications; and
    • Symptoms (e.g., cough, shortness of breath) have improved.
HCP with severe to critical illness who are not moderately to severely immunocompromised:
  • In general, when 20 days have passed since symptoms first appeared; and
    • At least 24 hours have passed since last fever without the use of fever-reducing medications; and
    • Symptoms (e.g., cough, shortness of breath) have improved.
HCP who are moderately to severely immunocompromised, may shed beyond 20 days after symptom onset or, for those who were asymptomatic throughout their infection, the date of their first positive viral test.
Use of a test-based strategy (2 negative tests 24 hours apart after symptom resolution) and consultation with an infectious disease specialist or other expert such as occupational health specialist is recommended to determine when these HCP may return to work.

Return to Work After Higher-Risk Exposure
HCP who have received all COVID-19 vaccine doses, including booster dose, as recommended by CDC; do not require work restriction unless they develop symptoms and test positive:
  • They must test as soon as possible after 24 hours from exposure and 5-7 days after exposure.
  • Continue to use source control masks and PPE as recommended by CDC (no change)
HCP who are either fully vaccinated but without a booster or are unvaccinated, should exclude from work for 7 days following the higher-risk exposure:
  • With a negative test 48 hours before returning to work; and
  • HCP did not develop symptoms
Return to Work After a Low-Risk Exposure
No work restrictions regardless of vaccination status but must continue to use source control masks and PPE per CDC recommendations. (no change)

The Low or High-Risk Exposure Definition is defined as:
  1. Being within 6 feet of a person with confirmed COVID-19 infection; OR
  2. Having unprotected direct contact with infectious secretions or excretions of the person with confirmed COVID-19 infection.
High-risk exposure is defined as:
  1. Exposure of HCP's eyes, nose, or mouth to material potentially containing COVID-19, particularly if these HCP were present in the room for an aerosol-generating procedure
  2. Prolonged contact >15 min with a person infected with COVID-19 (resident, visitor, or co-worker), especially if they were not using a source control mask or if the HCP was not using appropriate PPE during the encounter.
Low-risk exposure is defined as:
  1. Having body contact with the patient (e.g., rolling the patient) without gown or gloves, may impart some risk for transmission, particularly if hand hygiene is not performed and HCP then touch their eyes, nose, or mouth.
AHCA/NCAL and MHCA continues to advocate to the federal and state government for increased access to antigen tests and staff to help in long term care facilities, particularly as the Omicron variant spreads, which will increase the need for testing.

We strongly encourage providers to continue to strictly follow all other infection prevention and control practices, such as the use of PPE, source control masks and social distancing. Providers should review the CDC guidance on Interim Infection Prevention and Control Recommendations in Nursing Homes for more information. The new CDC guidance does not necessarily supersede local or state guidance nor OHSA guidance.

Boosters Recommended by January 1, 2022
Finally, residents and staff should aim to receive their boosters by January 1, 2022. The Omicron variant continues to rapidly spread across the U.S., and data continues to show the effective?ness of boosters in fighting this new variant. The urgency to get long term care residents and staff a booster has never been greater.
 
CDC is working on updating this guidance in the coming days to more closely align with the new return to work guidance for health care personnel.

Staff Contact: dwatford@mehca.org

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