Exposed: When healthcare workers become infected with COVID-19

Taking action after exposure

If a healthcare worker experiences an unprotected exposure to a patient with confirmed or suspected Covid-19, advise them to contact their supervisor or occupational health services immediately. In consultation with public health authorities, your facility should use CDC guidance and clinical judgment to assess the healthcare worker’s exposure risk, and then gauge work restrictions on that risk. (CDC, 2020a).

Assessing exposure risk

The CDC uses three categories to describe Covid-19 exposure risk:

• High-risk exposure – prolonged close contact with a patient with Covid-19 who wasn’t wearing a facemask while the healthcare worker’s nose and mouth were unprotected from potentially infectious material.
• Medium-risk exposure – prolonged close contact with a patient with Covid-19 who was wearing a facemask while the healthcare worker’s nose and mouth were unprotected from potentially infectious material.
• Low-risk exposure – brief interaction with a patient with Covid-19 or prolonged close contact with a patient who was wearing a facemask, while the healthcare worker was wearing a facemask or respirator (CDC, 2020a).

When a healthcare worker experiences medium- or high-risk exposure, state or local public health authorities assume responsibility for actively monitoring the healthcare worker for fever or respiratory symptoms. The CDC recommends that these authorities communicate with the exposed individual at least daily to monitor for symptoms.

It’s recommended that you exclude a healthcare worker with medium- or high-risk exposure from work for 14 days after the last exposure (CDC, 2020a). However, if staffing issues exist after options to improve staffing have been exhausted, your facility can permit an asymptomatic healthcare worker who has been exposed to work, after consultation with occupational health services (CDC, 2020a).

Taking time-out when symptoms of Covid-19 develop

If a healthcare worker develops symptoms of Covid-19 (fever, cough, difficulty breathing), advise them to stay home from work. Tell them to report their illness to the facility’s occupational health services.

Make sure that your sick time policies support public health guidelines and that your employees are familiar with these policies (CDC, 2020b).

Returning to work after confirmed or suspected Covid-19

Your healthcare facility can use one of two strategies to determine when a healthcare worker may return to work after Covid-19.

• Test-based strategy – negative results of a Food and Drug Administration emergency use authorized molecular assay for Covid-19 from at least two consecutive nasopharyngeal swab specimens collected at least 24 hours apart, resolution of fever (without the use of fever-reducing medications), and improvement of respiratory symptoms.
• Non-test-based strategy – at least seven days have passed since initial symptoms appeared, and at least three days (72 hours) have passed since resolution of fever (without the use of fever-reducing medications), and improvement of respiratory symptoms (CDC, 2020c).

When returning to work, have the healthcare worker adhere to the following practices:

• Wear a facemask when in the healthcare facility until symptoms completely resolve or until 14 days after initial symptom onset, whichever is longer.
• Avoid contact with severely immunocompromised patients until 14 days after initial symptom onset.
• Adhere to hand hygiene, respiratory hygiene, and cough etiquette practices.
• Report to occupational health services if respiratory symptoms worsen or recur (CDC, 2020c).

Responding to a staffing shortage crisis

If extenuating circumstances occur, and authorities determine that these recommended strategies can’t be followed because of staffing shortages, a healthcare worker may be evaluated for an earlier return to work. If a healthcare worker returns to work earlier than recommended, encourage the healthcare worker to follow the return to work strategies described above (CDC, 2020c).

Since information surrounding the Covid-19 virus continues to evolve, keep informed by checking the CDC’s Coronavirus Disease 2019 (Covid-19) webpage.

Lippincott Solutions note: for the latest coverage on Covid-19 by the Lippincott Nursing team, please visit nursingcenter.com/coronavirus.

References

Centers for Disease Control and Prevention. (2020). 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).

Centers for Disease Control and Prevention. (2020). Steps Healthcare Facilities Can Take Now to Prepare for Coronavirus Disease 2019 (Covid-19).

Centers for Disease Control and Prevention. (2020). Criteria for Return to Work for Healthcare Personnel with Confirmed or Suspected Covid-19 (Interim Guidance).

More reading and resources

2019 Novel Coronavirus: Covid-19

Covid-19: Rational Use of Personal Protective Equipment

Coronavirus: Infection Prevention and Control

About the author

Collette Bishop Hendler, RN, MS, MA, CIC, Editor-in-Chief, Lippincott Solutions, Point-of-Care, is certified by the Certification Board of Infection Control and Epidemiology, Inc. as an Infection Preventionist.