CDC’s recommendations for the assessment of and response to HCP exposures to SARS-CoV-2-infected patients have evolved as the incidence of COVID-19 in the United States has changed. Before recognized widespread transmission in the United States, CDC recommended an aggressive approach to identifying exposed HCP and included recommendations for restricting some HCP from work who had higher risk exposures. As community spread of COVID-19 became apparent in many areas and as transmission from asymptomatic individuals was recognized, this approach became impractical and diverted resources away from other critical infection prevention and control functions. In response, CDC advised facilities to consider forgoing formal contact tracing and work restrictions for HCP with exposures in favor of universally applied symptom screening and source control strategies.
This updated guidance describes a process for resumption of contact tracing and application of work restrictions that can be considered in areas where spread in the community has decreased and when capacity exists to perform these activities without compromising other critical infection prevention and control functions. It has been simplified to focus on exposures that are believed to result in higher risk for HCP (e.g., prolonged exposure to patients with COVID-19 when HCP’s eyes, nose, or mouth are not covered). Other exposures not included as higher risk, including 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. The specific factors associated with these exposures should be evaluated on a case by case basis; interventions, including restriction from work, can be applied if the risk for transmission is deemed substantial.
The operational definition of “prolonged” refers to a cumulative time period of 15 or more minutes during a 24-hour period, which aligns with the time period used in the guidance for community exposures and contact tracing. Although this definition can be used to guide decisions about work restriction, appropriate follow-up, and contact tracing, the presence of extenuating factors (e.g., exposure in a confined space, performance of aerosol-generating procedure) could warrant more aggressive actions even if the cumulative duration is less than 15 minutes. For the purposes of this guidance, any duration should be considered prolonged if the exposure occurs during performance of an aerosol generating procedure.1
Data are insufficient to precisely define the duration of time that constitutes a prolonged exposure. Until more is known about transmission risks, it is reasonable to consider a cumulative exposure of 15 minutes or more during a 24-hour period as prolonged. This could refer to a single 15-minute exposure to one infected individual or several briefer exposures to one or more infected individuals adding up to at least 15 minutes during a 24-hour period. However, any duration should be considered prolonged if the exposure occurred during performance of an aerosol generating procedure.
|Exposure||Personal Protective Equipment Used||Work Restrictions|
|HCP who had prolonged1 close contact2 with a patient, visitor, or HCP with confirmed COVID-193||
|HCP other than those with exposure risk described above||
|HCP with travel or community exposures should inform their occupational health program for guidance on need for work restrictions.|
Healthcare Personnel (HCP): HCP include, but are not limited to, emergency medical service personnel, nurses, nursing assistants, physicians, technicians, therapists, phlebotomists, pharmacists, students and trainees, contractual staff not employed by the healthcare facility, and persons not directly involved in patient care, but who could be exposed to infectious agents that can be transmitted in the healthcare setting (e.g., clerical, dietary, environmental services, laundry, security, engineering and facilities management, administrative, billing, volunteer personnel). For this guidance, HCP does not include clinical laboratory personnel.