Infection control: Guidance risk assessment HCP

COVID 19 actual name

• SARS-CoV-2

Stands for

• Severe Acute Respiratory Syndrome Coronavirus 2

Healthcare personnal (HCP)

• Anyone working in healthcare who may be exposed to patients or infectious materials

• Asymptomatic HCP with a higher-risk exposure usually do NOT need work restriction, regardless of vaccination status.

• They must monitor for symptoms and undergo testing.

Exposure alone ≠ stay home.

Positive test or symptoms = stay home.

Evaluating HCP with COVID-19 Symptoms

• Any HCP with even mild symptoms should be tested with

  • Nucleic acid test (NAAT)

  • OR antigen detection assays

2 types of COVID tests

NAAT (PCR/Molecular Test)

• One negative test is usually enough

• 2nd test needed if higher suspicion + work restriction

Antigen Test

• One negative is NOT enough
  

• Needs:

  • Second antigen test 48 hours later after first negative, OR

  • Confirm with a negative NAAT

PCR = one negative

Antigen = two negatives

Return to Work After COVID-19 Infection

Mild to Moderate Illness

• Not moderately/ severely immunocompromised

May return to work if:

• At least 7 days since symptoms first appear + negative viral test (antigen or NAAT) within 48 hrs of returning to work OR

• Return after 10 days if not tested from when symptoms first appear and

• Fever free for last 24 hours without fever reducing medication and

• Symptoms improved

Or use NAAT or antigen test

• Antigen — negative on 5th day and 48 hrs later

Asymptomatic Infection returning to work

• HCP that’s asymptomatic and not moderately or severely immunocompromised

May return to work if:

• 7 days since first positive test and obtain negative test within 48 hours of returning to work

• Return after 10 days if not tested from when symptoms first appear

Or use NAAT or antigen test

• Antigen — negative on 5th day and 48 hrs later

Severe Illness returning to work

• HCP with severe to critical illness & not moderately to severely immunocompromised

May return to work if:

• 10–20 days pass since first symptoms appeared and

• Fever free for 24 hours without fever reducing medications and

• Symptoms improved

Immunocompromised HCP returning to work

• May produce replication competent virus 20 days after symptoms

• Or from day of first positive viral test if Asymptomatic + immuno

Need:

• Individual evaluation

• Test-based strategy

• Infectious disease consultation

Test-Based Strategy

Symptomatic HCP can return to work if

• Fever resolved w/o medication and

• Symptoms improved and

• Two negative tests (Respiratory)

  • Tests collected 48 hours apart (Antigen or NAAT)

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Asymptomatic HCP can return to work if

• Two negative tests (Respiratory)

  • Tests collected 48 hours apart (Antigen or NAAT)

Higher-Risk Exposure (HCP who were exposed to people w/ confirmed COVID)

• High risk if HCP

  • Eyes, nose, mouth exposed to room/ material containing SARS-CoV-2

  • In room during aerosol generating procedures (AGPs)

• Official definition of higher risk exposure HCP

A. Prolonged close contact w/ patient, visitor, or confirmed COVID patient AND

• No respiratory protection (respirator) OR

• Only wearing facemask while infected person was not masked

B. No eye protection

• Not wearing eye protection AND

• Infected person not wearing mask

C. Missing PPE during aerosol— generating procedures

• HCP present during AGP without PPE (respirator, eye protection, gown, gloves)

Not High risk exposure

• NOT high risk

  • Body contact w/ patient (moving patient w/o gloves or gown)

  • Touching face before hand hygiene

Why not high risk?

• Depends on

  • Ventilation quality

  • PPE use

  • Source control (masking)

  • Duration of exposure

These cases should be evaluated — can change restrictions from work

After a Higher-Risk Exposure (testing)

After higher risk exposure, HCP should get tested 3 times

Exposure = day 0

• Day 1

  • 24 hrs after exposure

• Day 3

  • 48 hours after first negative test

• Day 5

  • 48 hours after second negative test

(each test 48 hours apart)

Who should get tested after higher risk exposure?

Asymptomatic people

• recovered from COVID in last 30 days — should not get tested

• Only test if recovered in the last 31-90 days

  • Antigen instead of NAAT recommended

  • NAAT may give false positive

What to do if HCP has covid symptoms?

• Not report to work when ill or positive

• Development of fever or symptoms = immediately self isolate and arrange medical evaluation/ testing

Asymptomatics after high exposure work restriction (not needed)

Most asymptomatic HCP do NOT need work restriction after high exposure regardless of vaccination status

Work restriction may be needed if:

• Cannot be tested

• Cannot wear source control

• Moderately/ severely Immunocompromised

• Works with immunocompromised patients

• HCP works for facility with ongoing COVID transmission that’s not controlled

If work restriction is required, HCP can:

• Return after 7 days with negative testing (no symptoms)

• Return after 10 days without testing (no symptoms)

Community and travel exposure

• Household exposure

• Friend/ travel exposure

Needs to be reviewed with occaptional health

• Close prolonged contact = same as higher risk workplace exposure

Prolonged exposure definition

• 15 minutes or more

• Several short exposures adding up to 15 minutes within 24 hours

• any duration = prolonged exposure if performing aerosol generating procedure

Close contact definition

• Being within 6 feet of confirmed COVID 19

• Unprotected contact w/ respiratory secretions, bodily fluids, excretions

Distance with 6+ feet is risky if

• Prolonged exposure

• Poor ventilation

Determining when a person w/ confirmed COVID is infectious

Infectious person w/ symptoms

• Exposure window (YOU might have spread covid to other people)

  • 2 days before symptoms onset (So if you developed symptoms June 10, anyone in contact with you 2 DAYS prior could be considered EXPOSED to the virus)

Why?

• People can spread the virus BEFORE they FEEL SICK

Infectious person w/o symptoms

• Determine exposure date

• Infectious period

If exposure date is unknown

• Assume starting point is 2 days before positive test —> until transmission precautions can be discontinued

Illness Severity

Mild

• Has COVID symptoms — no lung involvement

Symptoms such as:

• Fever

• Cough

• Sore throat

• Fatigue (malaise)

• Headache

• Muscle aches

What they DON’T have

• No shortness of breath

• No difficulty breathing (dyspnea)

• No abnormal chest imaging (xray/CT scan)

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Moderate

• Has COVID symptoms reaching lower respiratory tract (lungs) seen on chest imaging, but oxygen normal

• Oxygen saturation (SpO₂) ≥94%

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Severe

• Has COVID symptoms w/ significant breathing and oxygenation problems

Examples include:

• Respiratory rate >30 breaths/min

• Oxygen saturation SpO₂<94%

  • For people w/ chronic hypoxemia (low oxygen) — more thgan 3 % drop from normal baseline

• Poor oxygen exchange

  • PaO₂/FiO₂ ratio less than 300 mmHg

• Lung infiltrates

  • More than >50% lung affected

  • Seen on xray or CT

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Critical

• Has COVID symptoms w/ life threatening complications

Includes:

• Respiratory failure

• Septic shock

• Multiple organ dysfunction

Quick severity chart

Severity	Key Features
Mild	Symptoms only; no lung involvement
Moderate	Lung involvement + SpO₂ ≥ 94%
Severe	SpO₂ < 94%, RR > 30, major lung disease
Critical	Respiratory failure, septic shock, organ failure

Fever

Defined as:

• Feeling feverish OR

• Temperature 100.0°F (37.8°C) or higher

May not be present in elderly, immunocompromised, fever reducing medications, or NSAIDs

Face coverings

Facemasks

• Must be FDA or EUA cleared to be medical procedure masks

• Helps protect splashes, sprays

Respirators

• Must be CDC/NIOSH cleared to be medical procedure masks

• Minimize inhaling airbourne particles

Cloth masks

• Not PPE or healthcare approved