Early Infection Control Assessment and Response Visits:
Lessons Learned
Topic 4 : Screening and Symptom Monitoring for Healthcare Personnel
In early April 2020, the DPH Healthcare-Associated Infections (HAI) Prevention Program began performing telephone-based, COVID-19-focused infection control assessment and response visits (ICARs) with long-term care facilities (LTCF) around the state.
ICARs are educational discussions that cover a range of infection prevention and control topics that can impact the spread of COVID-19 within a facility. ICARs provide opportunities for questions and discussion, a review of policies and practices, and "just in time" education.
The HAI program and its partners in this effort, including the Superior Health Quality Alliance and local health departments, have conducted more than 190 ICARs to date.
This "Early ICAR Lessons Learned" series of messages will highlight common recommendations and clarifications our team of infection preventionists are making during these calls, as they promote best practices and alignment with CDC and DHS guidance.
Screening and Symptom Monitoring for Healthcare Personnel
Proactive symptom monitoring of healthcare facility staff, enforcement of evidence-based return to work policies, and collaboration with local health departments are integral to protecting the state’s healthcare personnel, patients, and residents from exposure and preventing outbreaks.
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Each healthcare facility should have an active screening program in place that assesses everyone who enters the facility, including healthcare personnel (HCP), for symptoms consistent with COVID-19, as well as exposure to others with SARS-CoV-2 infection. Active screening includes the following CDC recommendations:
- Actively taking temperatures of everyone entering the facility and documenting absence of symptoms consistent with COVID-19
- Asking everyone entering the facility if they have been advised to self-quarantine because of exposure to someone with SARS-CoV-2 infection
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It is important that healthcare facilities educate staff about the full range of COVID-19 symptoms currently on the CDC website, including both respiratory and other symptoms. Some facility outbreaks have been linked to staff who only had gastrointestinal (GI) symptoms, headache, or sore throat. Staff should also be reminded about the facility’s sick leave policies and procedures for all conditions. Per CDC, symptoms of COVID-19 include:
- Fever (either measured as temperature ≥100.0F or subjective fever) or chills
- Cough
- Shortness of breath or difficulty breathing
- Fatigue
- Muscle or body aches
- Headache
- New loss of taste or smell
- Sore throat
- Congestion or runny nose
- Nausea or vomiting
- Diarrhea
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Each healthcare facility should have a clear process for staff exposures and exclusions. Per CDC work exposure guidance, any staff who had prolonged close contact (i.e., within six feet for at least 15 minutes, or any length of time for an aerosol-generating procedure) with a patient, visitor, or HCP with confirmed COVID-19 and was not wearing appropriate PPE, should be excluded from work for 14 days. Any staff person who develops symptoms consistent with COVID-19 should immediately contact their established point of contact (e.g., occupational health program) to arrange for medical evaluation and testing. Per CDC and DHS HAN 16, staff who have close contact with a person infected with COVID-19 in a household or community setting should typically be excluded from work for 14 days unless the healthcare facility determines doing so would prevent safe clinical operations.
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Facilities should utilize CDC's time-based or symptom-based return to work strategies for staff who test positive for SARS-CoV-2. A test-based strategy is no longer recommended because, in the majority of cases, it results in extended exclusion of staff who continue to shed detectable SARS-CoV-2 RNA, but are no longer considered infectious. Decisions about return to work for healthcare personnel with SARS-CoV-2 infection should be made in the context of local circumstances and CDC guidance.
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Healthcare facilities should work with their local health department for outbreak management, PPE needs, and testing concerns. All suspected and confirmed cases of COVID-19 among staff, patients, and residents are Category I reportable conditions and should be reported to the local health department. Local health departments will assist facilities based on cases reported, including facilitating local and state response resources, as needed.
Note that the recommendations highlighted here do not replace the value of a facility having its own ICAR, or the need to stay current on CDC and DHS guidelines. ICARs are non-regulatory and complement infection control surveys, with a focus on education and infection prevention.
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