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[August 13, 2020] Updated CDC Guidance on Return to Work Criteria and Discontinuation of Transmission-Based Precautions - IHCA

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[August 13, 2020] Updated CDC Guidance on Return to Work Criteria and Discontinuation of Transmission-Based Precautions

Posted Aug 13, 20205 min Read

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On August 10, 2020, the federal Centers for Disease Control and Prevention (CDC) updated its Return to Work Criteria for health care personnel (HCP) with COVID-19, which provides:

  • Generally, the CDC no longer recommends the test-based strategy to determine when to allow HCP to return to work; the CDC states that in the majority of cases, a test-based strategy results in excluding HCP from work who continue to shed detectable SARS-CoV-2 RNA but who are no longer infectious.
  • The CDC instead recommends the symptom-based strategy, although decisions about return to work for HCP should always be made in the context of local circumstances.
  • The CDC has developed two symptom-based strategies based on whether a HCP has a mild to moderate illness, or a HCP has a severe to critical illness or is severely immunocompromised. These same symptom-based strategies are also applicable to the CDC’s updated Discontinuation of Transmission Based Precautions, as outlined further below.
  • The August 10th updates to the CDC’s Return to Work Criteria and Discontinuation of Transmission Based Precautions specifically change the timeframe for those with a severe illness or who are severely immunocompromised.  Previous guidance recommended at least 20 days since symptoms first appeared; the updated guidance recommends at least 10 days and up to 20 days.  The updated guidance also recommends consideration of consultation with infection control experts for those same patients.

The symptom-based strategy for those HCP with mild to moderate illness who are not severely immunocompromised recommends works exclusion until:

  • At least 10 days have passed since symptoms first appeared, at least 24 hours have passed since an individual’s last fever without the use of fever-reducing medications, and symptoms (i.e., cough, shortness of breath) have improved. The previous CDC guidance required 72 hours to have passed since an individual’s last fever without the use of fever-reducing medications and respiratory symptoms to have improved.
  • HCP who are not severely immunocompromised and who were asymptomatic throughout their infection may return to work when at least 10 days have passed since the date of their first positive viral diagnostic test.
  • The CDC defines “mild illness” as individuals who have any of the various signs and symptoms of COVID-19 (i.e., fever, cough, sore throat, headache, muscle pain) without shortness of breath, dyspnea, or abnormal chest imaging,  The CDC defines “moderate illness” as individuals who have evidence of lower respiratory disease by clinical assessment or imaging and a saturation of oxygen (SpO2) ≥94% on room air at sea level.

The symptom-based strategy for those HCP with severe to critical illness or who are severely immunocompromised recommends work exclusion until:

  • At least 10 days and up to 20 have passed since symptoms first appeared, at least 24 hours have passed since an individual’s last fever without the use of fever-reducing medications, and symptoms (i.e., cough, shortness of breath) have improved. Consideration of consultation with infection experts is also recommended.  Previous CDC guidance required 72 hours to have passed since an individual’s last fever without the use of fever-reducing medications and respiratory symptoms to have improved and also recommended 20 days to have passed since symptoms having first appeared, rather than providing the 10 to 20 day timeframe.
  • HCP who are severely immunocompromised but who were asymptomatic throughout their infection may return to work when at least 10 days and up to 20 days have passed since the date of their first positive viral diagnostic test.
  • The CDC defines “severe illness” as individuals who have respiratory frequency >30 breaths per minute, SpO2 <94% on room air at sea level (or, for patients with chronic hypoxemia, a decrease from baseline of >3%), ratio of arterial partial pressure of oxygen to fraction of inspired oxygen (PaO2/FiO2) <300 mmHg, or lung infiltrates >50%.

The CDC also updated its Discontinuation of Transmission-Based Precautions for patients with COVID-19 in a health care setting based upon the same changes outlined in the updated Return to Work Criteria. Like the Return to Work Criteria, the CDC has developed two symptom-based strategies based on whether a patient has a mild to moderate illness, or a patient has a severe to critical illness or is severely immunocompromised, with the same updated timeframes.

access a chart outlining symptom-based strategies for discontinuation of transmission-based precautions

Based on the updates to the CDC’s Discontinuation of Transmission-Based Precautions, the Indiana State Department of Health has updated the Guidance for Hospital Discharge to Long-Term Care Facilities and Visitation Guidelines to reflect the new timelines of the Transmission-Based Precautions, which generally allow removal 10 days after the symptoms first appeared, 24 hours having passed since an individual’s last fever without the use of fever-reducing medications, and the individual’s symptoms having improved.

If you have any questions, please contact Lori Davenport at Ldavenport@ihca.org or Laura Brown at Lbrown@ihca.org.