Category: Infection Control
Question: A healthcare provider at our facility was recently diagnosed with COVID-19. What time period and criteria do we use to determine the patients, visitors, and other healthcare personnel (HCP) who might have been exposed to this individual while he/she was potentially infectious?
Answer: Anyone who had prolonged close contact (within 6 feet for a cumulative total of 15 minutes or more over a 24-hour period) with the infected healthcare provider might be at risk for transmission. If the provider had COVID-19 symptoms, the provider is considered potentially infectious beginning 2 days before symptoms first appeared until the provider meets criteria to return to work. If the provider did not have symptoms, collecting information about when the provider may have been exposed could help inform the period when they were infectious. If an exposure is identified. The provider should be considered potentially infectious beginning 24 hours after the exposure until criteria to return to workare met. If the date of exposure cannot be determined. For the purposes of contact tracing, it is reasonable to use a cutoff of 2 days before the specimen testing positive for SARS-CoV-2 was collected as the starting point, continuing until the criteria to criteria to return to workare met. Contact tracing is generally recommended for anyone who had prolonged close contact with the person with SARS-CoV-2 infection during these time periods.  While this question addresses exposure to a potentially infectious provider, the following actions are also recommended if the potentially infectious individual is a patient or visitor. Recommended actions for HCP, patients, and visitors: Perform a risk assessment and perform testing and apply work restrictions for other HCP who were exposed to the infected provider as described in the Interim Guidance for Managing Healthcare Personnel with SARS-CoV-2 Infection or Exposure to SARS-CoV-2. Test and manage exposed patients who are currently admitted to the healthcare facility as described in the Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the COVID-19 Pandemic Perform contact tracing of exposed patients who are not currently admitted to the healthcare facility and for visitors as described in the Interim Guidance on Developing a COVID-19 Case Investigation and Contact Tracing Plan: Overview. Healthcare facilities should have a process for notifying the health department about known or suspected cases of SARS-CoV-2 infection, and should establish a plan, in consultation with local public health authorities, for how exposures in a healthcare facility will be investigated and how contact tracing will be performed.  The plan should address the following: Who is responsible for identifying contacts and notifying potentially exposed individuals? How will such notifications occur? What actions and follow-up are recommended for those who were exposed? Contact tracing should be carried out in a way that protects the confidentiality of affected individuals to the extent possible and is consistent with applicable laws and regulations.  HCP and patients who are currently admitted to the facility or were transferred to another healthcare facility should be prioritized for notification.  These groups, if infected, have the potential to expose a large number of individuals at higher risk for severe disease, or in the situation of admitted patients, be at higher risk for severe illness themselves. Information for health departments about case investigation and contact tracing is available in the Interim Guidance on Developing a COVID-19 Case Investigation and Contact Tracing Plan: Overview.  This guidance could also be helpful to healthcare facilities performing such activities.