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What can I do to mitigate healthcare staffing shortages that have occurred as a result of COVID-19?

CDC has guidance documents on Strategies to Mitigate Healthcare Personnel Staffing Shortages.

Healthcare facilities should have documented plans and processes in place to mitigate staffing shortages, including considerations for permitting healthcare personnel (HCP) to return to work without meeting all return-to-work (RTW) criteria.

Considerations for developing criteria to determine which HCP with suspected or confirmed COVID-19 (who are well enough and willing to work) could return to work in a healthcare setting before meeting all Return-to Work-Criteria—if staff shortages continue despite other mitigation strategies:

    • The type of HCP shortages that need to be addressed.
    • Where individual HCP are in the course of their illness (e.g., viral shedding appears to be higher earlier in the course of illness).
    • The types of symptoms they are experiencing (e.g., persistent fever).
    • Their degree of interaction with patients and other HCP in the facility (e.g., working in telemedicine services, providing direct patient care, working in a satellite unit reprocessing medical equipment).
    • The type of patients they care for (e.g., immunocompromised patients, only patients with SARS-CoV-2 (the virus that causes COVID-19) infection).

As part of planning, healthcare facilities (in collaboration with risk management) should inform patients and HCP when the facility is operating under crisis standards, the changes in practice that should be expected, and actions that will be taken to protect them from exposure to COVID-19 if HCP with suspected or confirmed COVID-19 are allowed to work.

If HCP are allowed to work before meeting all criteria, facilities should consider prioritizing their duties in the following order:

  1. If not already done, allow HCP with suspected or confirmed COVID-19 to perform job duties where they do not interact with others (e.g., patients, other HCP), such as in telemedicine services.
  2. Allow HCP with confirmed COVID-19 to provide direct care only for patients with confirmed COVID-19, preferably in a cohort setting.
  3. Allow HCP with confirmed COVID-19 to provide direct care for patients with suspected COVID-19.
  4. As a last resort, allow HCP with confirmed COVID-19 to provide direct care for patients without suspected or confirmed COVID-19.

They should still adhere to all Return-to-Work Practices and Work Restrictions, including:

  • Wearing a facemask for source control at all times while in the healthcare facility until they meet the full Return-to-Work Criteria and all symptoms are completely resolved or at baseline. A facemask instead of a cloth face covering should be used by these HCP for source control during this time period while in the facility. After this time period, these HCP should revert to their facility policy regarding universal source control during the pandemic.
    • A facemask for source control does not replace the need to wear an N95 or higher-level respirator (or other personal protective equipment (PPE)) when indicated, including when caring for patients with suspected or confirmed COVID-19.
  • Being reminded that in addition to potentially exposing patients, they could also expose their co-workers.
    • Facemasks should be worn even when HCP are in non-patient care areas, such as breakrooms.
    • If HCP must remove their facemask, for example, to eat or drink, they should separate themselves from others.
  • Being restricted from contact with severely immunocompromised patients (e.g., transplant, hematology-oncology) until the full Return-to-Work Criteria have been met.
  • Self-monitoring for symptoms and seeking re-evaluation from occupational health if respiratory symptoms recur or worsen.

Considerations for healthcare facilities when developing criteria to allow asymptomatic HCP who have had an unprotected exposure to SARS-CoV-2 but are not known to be infected to continue to work:

  • These HCP should still report temperature and absence of symptoms each day before starting work.
  • These HCP should wear a facemask (for source control) while at work for 14 days (this is the time period during which exposed HCP might develop symptoms (i.e., the current incubation period for the virus)) after the exposure event.
  • These HCP should use a facemask instead of a cloth face covering for source control during this time period while in the facility. After this time period, these HCP should revert to their facility policy regarding universal source control during the pandemic.
    • A facemask for source control does not replace the need to wear an N95 or equivalent or higher-level respirator (or other PPE) when indicated, including for the care of patients with suspected or confirmed COVID-19.
  • Post-exposure testing during the 14-day post-exposure period should be performed to more quickly identify pre-symptomatic or asymptomatic HCP who could contribute to SARS-CoV-2 transmission.
    • Facilities that elect to perform post-exposure testing of HCP should be aware that testing might be logistically challenging and has limitations. For example, testing only identifies the presence of virus at the time of the test.
    • It is possible that HCP can test negative because they are early in their infection when their sample is collected. In such situations, they could become infectious later and transmit the virus to others; for this reason, repeat testing could be considered.
    • Also, when there is SARS-CoV-2 transmission occurring in the community, positive tests in HCP do not necessarily indicate transmission due to exposures in the workplace.
    • If testing of exposed HCP is instituted, test results should be available rapidly (i.e., within 24 hours), and there should be a clear plan to respond to results.
    • Considerations for testing time frames:
        • CDC expanded viral testing in nursing homes includes initial testing of all HCP followed by repeat testing of all previously negative HCP, generally between every 3 days to 7 days, until the testing identifies no new cases of SARS-CoV-2 infection among residents or HCP for a period of at least 14 days since the most recent positive result.  Expanded viral testing of HCP could also be considered in other healthcare settings in some situations (e.g., when multiple instances of SARS-CoV-2 transmission are identified among patients or HCP).
        • **Some practices and health departments have established testing time frames at days 5 and 7 post exposure to allow time for the presence of the virus to show.
        • **There have been reported cases that tested negative on day 2 post exposure and positive on day 5 post exposure.
        • **These considerations are based on discussions with practices and health departments during the COVID-19 pandemic.
  • If HCP develop even mild symptoms consistent with COVID-19, they must cease patient care activities and notify their supervisor or occupational health services prior to leaving work.
  • HCP with suspected COVID-19 infection should be prioritized for testing, as testing results will impact when they may return to work and the patients for whom they might be permitted to provide care.
  • If HCP are tested and found to be infected with COVID-19 infection, they should be excluded from work until they meet all Return-to-Work Criteria.

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All Curi recommendations are based on current CDC criteria at the time of publication. CDC guidance for SARS-CoV-2 infection may, or may not, be adopted by state and local health departments to respond to rapidly changing local circumstances. Providers should always check with their local health department to see if the CDC’s guidance on any given topic has been modified (particularly if more restrictive) from the CDC’s recommended guidelines. Follow this link https://www.cdc.gov/publichealthgateway/healthdirectories/index.html for contact information to your state/local health department. If local recommendations vary from those of the CDC, and you are unsure what recommendations to follow, then it is safer to follow the more restrictive guidelines/recommendations.