Health Care Worker Isolation and Quarantine Recommendations - Minnesota Dept. of Health
CDC has recently updated their Interim Guidance for Managing Healthcare Personnel with SARS-CoV-2 Infection or Exposure to SARS-CoV-2. MDH is working to review the CDC guidance and update our documents as appropriate.

Health Care Worker Isolation and Quarantine Recommendations

In consultation with medical, legal, and occupational health leadership, health care settings should use guidance from the Centers for Disease Control and Prevention (CDC) to establish protocols for isolation and quarantine of health care workers during conventional, contingency, and crisis staffing situations.

Supplemental guidance on isolation, quarantine, and staffing shortages

The purpose of this webpage is to provide additional information based on common questions about health care worker isolation, quarantine, and staffing shortages data received by the Minnesota Department of Health (MDH). This page offers supplemental recommendations to the foundational CDC recommendations, linked above, which this page does not address in detail. Prior to reviewing these supplemental recommendations, health care settings should first review the complete CDC guidance.

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General

CDC guidance for managing health care workers should be applied to all health care settings in Minnesota, including long-term care facilities.

Health care workers are paid and unpaid people serving in health care settings who have the potential for direct or indirect exposure to patients, other health care workers, 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.

Health care workers include, but are not limited to, the following people working in a health care setting: emergency medical service personnel; nurses; nursing assistants; home health care personnel; physicians; technicians; therapists; phlebotomists; pharmacists; dental health care personnel; students and trainees; contractual staff; office workers; dietary staff; environmental services; laundry staff; security; engineering and facilities management; administrative staff; billing staff; and volunteers.

The State of Minnesota extends employment protections to people complying with MDH recommendations for isolation and quarantine, Minnesota Statutes Section 144.4196. MDH recommendations for isolation and quarantine align with CDC guidelines for isolation and quarantine during conventional staffing capacity situations. Health care workers can choose to return to work early if asked by an employer experiencing contingency or crisis staffing capacity. However, even in contingency or crisis situations, these employment protections apply to health care workers who choose to stay home for the full conventional isolation or quarantine period.

Staffing capacity

It is up to the facility to decide what phase of staffing they are in. Facilities should have a low threshold for contacting MDH to ask about staffing resources and assistance. The resource below has descriptions of the staffing capacities, which can be used as a guide.

Ethical Framework for Transitions Between Conventional, Contingency, and Crisis Conditions in Pervasive or Catastrophic Public Health Events with Medical Surge Implications (PDF)

CDC's mitigation strategies offer a continuum of options for addressing staffing shortages. Contingency strategies, followed by crisis capacity, augment conventional strategies and are meant to be considered and implemented sequentially (i.e., implementing contingency strategies before crisis strategies). However, facilities can choose to be more conservative in their staffing strategies, as staffing resources allow. For example, a facility may consider using crisis strategies for exposed health care workers but continue to use contingency strategies for infected health care workers until their staffing resources are exhausted.

Health care facilities (in collaboration with risk management) should inform patients and health care workers when the facility is using these strategies, specify the changes in practice that should be expected, and describe the actions that will be taken to protect patients and health care workers from exposure to SARS-CoV-2 if health care workers with suspected or confirmed SARS-CoV-2 infection are asked to work to fulfill staffing needs.

Evaluating health care workers with symptoms of SARS-CoV-2 infection

Any health care worker who is experiencing symptoms, even mild, consistent with SARS-CoV-2 infection should leave work immediately and be tested. If a health care worker tests negative for SARS-CoV-2 and continues to experience symptoms, the health care worker should follow the guidance below:

  • If symptoms are consistent with a known, chronic health condition or they are evaluated by a health care provider and receive an alternate diagnosis, the health care worker may return to work when appropriate. The decision to return should be based on the health care worker's symptoms and ability to work, and guidance from the health care worker's provider, manager, and occupational health department.
  • If the health care worker does not have an alternate diagnosis from a health care provider, they may return to work if symptoms are improving and they have been fever-free for at least 24 hours without the use of fever-reducing medication.
  • As testing resources allow, a second test at least 24 hours after the initial negative test is recommended before the health care worker returns to work in any of the following situations:
    • The health care worker had a known higher-risk exposure.
    • The initial negative test was an antigen test.
    • The health care worker continues to experience symptoms, especially those that would interfere with continuous mask or respirator use for source control (e.g., runny nose).

Return-to-work criteria for health care workers infected with SARS-CoV-2

Mild illness: those who experience any of the various signs and symptoms of COVID-19 (e.g., fever, cough, sore throat, malaise, headache, muscle pain), without shortness of breath, dyspnea, or abnormal chest imaging.

Moderate illness: those who have evidence of lower respiratory disease, by clinical assessment or imaging, and a saturation of oxygen (SpO2) higher than 94% on room air at sea level.

CDC specifies the following criteria for symptomatic health care workers to return to work:

  • At least 24 hours has passed since last fever without the use of fever-reducing medications.
  • Symptoms (e.g., cough, shortness of breath) have improved.

MDH recommends these additional considerations, which will help ensure returning health care workers are able to wear a well-fitting mask or respirator continuously:

  • Not have rhinorrhea (runny nose).
  • Have no more than a minimal, nonproductive cough.

A subsequent positive test collected during isolation does not "reset" or lengthen the recommended isolation period of 10 days. For example, under conventional staffing, if a health care worker tests positive after day five of isolation, they can return after 10 days of isolation, provided the health care worker meets the above return-to-work criteria.

CDC provides considerations for facilities under contingency and crisis staffing scenarios to allow infected health care workers who are well enough and willing to work to return to work early, including:

  • The type of staffing shortages that need to be addressed in the facility (e.g., intensive care unit nurses, nursing assistants, environmental service workers, etc.).
  • Where individual health care workers are in the course of their illnesses. Viral shedding is likely higher earlier in the course of illness, so health care workers who are later in their course could be prioritized for early return to work.
  • The type of symptoms a health care worker is experiencing (e.g., persistent fever, cough).
  • The degree of interaction (e.g., direct patient care, telemedicine, administrative) a health care worker has with patients and other health care workers in the facility.
  • The type of patients a health care worker cares for. Consider the tiered approach as follows:
    • Allow health care workers with suspected or confirmed SARS-CoV-2 infection to perform job duties where they do not interact with others (e.g., patients or other health care workers), such as in telemedicine services.
    • Allow health care workers with confirmed SARS-CoV-2 infection to provide direct care only for patients with confirmed SARS-CoV-2 infection, preferably in a cohort setting.
    • Allow health care workers with confirmed SARS-CoV-2 infection to provide direct care only for patients with suspected SARS-CoV-2 infection.
    • As a last resort, allow health care workers with confirmed SARS-CoV-2 infection to provide direct care for patients without suspected or confirmed SARS-CoV-2 infection. This should be used only as a bridge to longer-term strategies that do not involve care of uninfected patients by potentially infectious health care workers. Strict adherence to all other recommended infection prevention and control measures is essential.

Health care workers who return before meeting all conventional return-to-work criteria should adhere to the following recommendations:

  • Self-monitor for symptoms and seek re-evaluation from occupational health if symptoms recur or worsen.
  • Wear a respirator or well-fitting facemask at all times, even in nonpatient care areas, such as breakrooms.
  • Practice physical distancing as much as possible.
  • Avoid interacting with patients who do not wear or cannot tolerate a well-fitting mask.

CDC's updated guidance for health care workers' return to work while a facility is in contingency staffing status does not apply to health care workers who are moderately to severely immunocompromised. Immunocompromised health care workers should follow conventional isolation and return-to-work guidance during contingency staffing situations. As a last resort in crisis staffing situations, health care settings may consider asking health care workers who are moderately to severely immunocompromised to work prior to meeting all conventional return-to-work guidance.

Work restrictions for health care workers exposed to SARS-CoV-2

Health care workers are considered "up to date" on vaccination if they have received all recommended COVID-19 vaccine doses, including a booster dose if eligible. Health care workers who have completed a primary vaccination series, but are not yet eligible for a booster dose, are included in the "up-to-date" category, since they are current on all recommended vaccines at the time.

For current CDC recommendations on COVID-19 primary series and booster vaccination, refer to CDC: Stay Up to Date with Your Vaccines.

  • If the health care worker is not up to date on vaccination:
    • In conventional staffing capacity situations, exclude the health care worker from work for 10 days after their last exposure, or for seven days after the last exposure if a specimen collected within 48 hours before returning to work is negative for SARS-CoV-2. If the health care worker is not able to isolate from the positive household member, the last day of exposure is the last day the household member is considered infectious (generally 10 days).
    • When applying contingency and crisis capacity strategies, there are no work restrictions, but the health care worker should be tested frequently (e.g., days one, two, three, and five to seven following exposure, and every three to seven days with the final test occurring five to seven days after last exposure), based on testing availability.
  • If the health care worker is up to date on vaccination:
    • There are no work restrictions. Test immediately (but not earlier than 24 hours) following exposure, and every three to seven days, with the final test occurring five to seven days after their last exposure (i.e., last day the positive household member is considered infectious). If the health care worker is not able to isolate from the positive household member, the last day of exposure is the last day the household member is considered infectious (generally 10 days).

Health care worker exposure risk assessment

A risk assessment should be done for health care workers who are exposed to an infected patient, resident, coworker, or visitor. CDC has updated the definition of higher-risk exposure for health care workers who are exposed to someone who is not wearing a facemask or cloth mask in a health care setting. If a health care worker is not wearing a respirator and eye protection when in prolonged close contact with an infectious person, and that infectious person is not wearing a facemask (medical-grade or cloth), this is a higher-risk exposure.

Testing

Refer to CDC: Interim Guidance for Antigen Testing for SARS-CoV-2: Interpreting the Results of Antigen Testing for when to perform confirmatory nucleic acid amplification testing (NAAT) after a positive or negative antigen test. There are different recommendations for congregate settings (e.g., long-term care facilities) and community settings (e.g., acute care facilities).

Home tests are not preferred for testing health care workers. CDC recommends point-of-care or laboratory-based testing when testing resources allow. If home tests are used, facilities could consider performing a second test at least 24 hours following an initial negative test and having health care workers present for a proctored test to ensure appropriate collection and interpretation of test results.

Please also refer to the U.S. Food and Drug Administration (FDA) for information regarding performance of available tests on the variants currently circulating in the United States.

Testing after prior infection

Health care workers who are within 90 days of infection with SARS-CoV-2 should be tested in the following situations:

  • Testing is needed to return to work prior to completion of 10-day isolation because of SARS-CoV-2 infection.
  • They are experiencing symptoms consistent with COVID-19, and other etiologies have been ruled out. In this situation, an antigen test is preferred.

Testing health care workers who are within 90 days of infection is not recommended in the examples below:

  • Routine testing, such as routine staff screening and point-prevalence surveys.
  • Testing after a higher-risk exposure.

Higher-risk exposures

Health care facilities are responsible for conducting risk assessments and notifying staff members of their exposure. Facilities should send the following document to health care workers with a higher-risk exposure:

Reporting clusters in health care facilities

Long-term care facilities, including group homes, skilled nursing facilities, assisted living facilities, and acute care facilities should report using the forms and instructions found at Reporting COVID-19/SARS-CoV-2 Clusters in Health Care Facilities.

Resources

Updated Friday, 23-Sep-2022 16:01:05 CDT