CDC Updates COVID-19 Recommendations for Health Care Settings

On Sept. 23, 2022, the Centers for Disease Control and Prevention (CDC) issued updates to its COVID-19 infection prevention guidance for health care personnel and guidance for managing exposed and infected health care personnel. It also retired its nursing home-specific infection prevention guidance and incorporated guidance for nursing homes into the more general guidance. In addition, the Centers for Medicare and Medicaid Services (CMS) updated its nursing home visitation guidance, QSO 20-39-NH, and its testing guidance, QSO 20-38-NH, to align with the CDC guidance.

The new documents are available at the following links:

• All health care settings: Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the COVID-19 Pandemic
• All health care settings: Interim Guidance for Managing Healthcare Personnel with SARS-CoV-2 Infection or Exposure to SARS-CoV-2
• Nursing Home Testing: QSO 20-38-NH
• Nursing Home Visitation: QSO 20-39-NH

High-Level Changes

Health care settings will continue to use community transmission rates to inform infection prevention and control practices, rather than the COVID-19 Community Levels utilized by the general public. Using community transmission rates allows providers to adjust interventions earlier, mitigating the strain on the health care system and protecting the vulnerable individuals seeking care in health care settings. The CDC recommends that health care settings check community transmission rates on a weekly basis to best determine infection control practices based on current conditions.

Health care setting recommendations will no longer be based on vaccination status. Mitigation measures such as source control, quarantine/work restriction, and screening testing will be the same for all individuals in applicable circumstances, regardless of whether the individual is or is not up-to-date with COVID-19 vaccination.

Screening of Staff and Visitors Entering the Health Care Setting

The CDC no longer recommends active screening of staff and visitors entering a health care setting for COVID-19 symptoms or exposure. Active screening means monitoring those entering the health care setting by use of a live person or assistive technology such as electronic monitoring systems and applications. Health care settings may opt to continue active screening or may revert to the use of passive screening techniques, such as signage describing the symptoms of COVID-19 and advising against entering the health care setting should the staff member or visitor experience symptoms or exposure. Nursing home staff should additionally be instructed to report to occupational health or another contact designated by the nursing home any symptoms of COVID-19, positive SARS-CoV-2 test results, or high-risk exposures.

Source Control

Health care settings will continue to utilize community transmission rates to inform source control decisions. Source control, including a respirator or well-fitting face mask, continues to be recommended for all individuals in a health care setting, including staff, residents/patients, and visitors, when the health care setting is located in an area of high community transmission.

Additionally, source control is recommended regardless of community transmission rates for individuals who:

• Have a confirmed or suspected respiratory infection. This includes respiratory infections that are not COVID-19 infections, such as cold or flu;
• Have had close contact with someone with SARS-CoV-2 infection, until 10 days after exposure;
• Reside or work in an area of the health care setting experiencing a SARS-CoV-2 outbreak. Remember that an outbreak is still defined as a single case of COVID-19; or
• Have otherwise had source control recommended by public health authorities.

Universal source control is no longer recommended in health care settings in areas of substantial, moderate, or low community transmission, except for individuals who meet the above criteria. This means that staff may perform care without the use of eye protection or a well-fitting face mask if they are in areas of substantial, moderate, or low community transmission and the above criteria are not met.

The CDC states that individuals should always be permitted to wear source control according to their preferences, even when not otherwise required by the health care setting. Health care settings in areas of high community transmission also may consider implementing staff use of N95 or similar respirators for certain situations such as aerosol-generating procedures and eye protection during patient care encounters, though this is a consideration, not a recommendation.

Asymptomatic Screening Testing

The CDC no longer recommends routine screening testing of asymptomatic health care personnel based on community transmission rates. CMS has updated nursing home testing requirements in memo QSO-20-38-NH accordingly. Nursing homes must continue to adhere to state laws, including any states that require routine screening testing of staff. Additionally, these updates to CDC recommendations do not supersede individual nursing home policies where routine screening testing may be required as an “additional precaution” for individuals who have received exemption from COVID-19 vaccination. The nursing home may adjust its policies as it sees fit.

A series of three tests is recommended for individuals in health care settings (residents/patients and staff) following SARS-CoV-2 exposure, regardless of the individual’s vaccination status. Asymptomatic residents/patients who have had a close contact exposure and staff who have had a high-risk exposure should be tested immediately (but generally not earlier than 24 hours after exposure) on Day 1 post-exposure. Negative tests should be repeated in 48-hour intervals, on Day 3 and Day 5 post-exposure.

The CDC has updated testing recommendations around individuals who have previously recovered from COVID-19. Individuals are not recommended for asymptomatic screening testing if they have recovered in the past 30 days, as opposed to previous recommendations to refrain from testing for 90 days. If individuals who have previously recovered from COVID-19 in the past 30 days must be tested, the CDC continues to recommend utilizing antigen tests for these individuals. The CDC additionally recommends utilizing antigen tests when testing individuals who have recovered from COVID-19 in the past 31-90 days.

Quarantine and Work Restriction

Quarantine is no longer recommended for asymptomatic residents/patients or visitors to health care settings following exposure. The CDC also no longer recommends quarantine of asymptomatic new admissions/readmissions to the nursing home. New admissions/readmissions in areas of high community transmission and individuals who have been identified as having been exposed to SARS-CoV-2 should continue to monitor for symptoms, complete a series of three screening tests as outlined above, and wear source control for 10 days following exposure. Individuals should be promptly isolated or restricted from work if symptoms develop or testing is positive for SARS-CoV-2 infection.

Isolation/Work Restriction for Suspected or Confirmed COVID-19

Recommendations for the duration of isolation of residents or work restriction of health care personnel have not changed. Individuals who test positive for COVID-19 should be isolated in their rooms or restricted from work for a period of 10 days. Staff may return to work after Day 7 with a negative viral test. Return-to-work recommendations can be reviewed here. Providers should take note that the CDC has clarified expectations around designated COVID-19 units and staffing. Dedicated COVID-19 units and staffing could be considered for managing residents/patients with SARS-CoV-2 infection in situations where staffing crises are not present and case numbers are high. In situations where staffing crises are present or the number of cases is low, residents/patients can remain isolated in place, ideally in a private room. Cohorting continues to be recommended only for those with the same respiratory pathogen. Recommendations for the use of personal protective equipment (PPE) in caring for these individuals remain unchanged.

Outbreak Response

CDC recommendations for outbreak response in nursing homes remain unchanged. Nursing homes may elect to conduct outbreak testing based either on contact tracing or a broad-based approach that tests all individuals on the affected unit or all individuals living and working in the nursing home. The CDC recommends that if ongoing transmission is identified, nursing homes should consider implementing isolation/work restriction for those identified with close contact or high-risk exposure and testing should be expanded to a broad-based approach if not already in use.

Assisted Living

Assisted living members will note that the CDC’s new recommendations offer assisted living the flexibility to determine whether residents and staff are better served and protected by following health care setting recommendations or the more flexible congregate care setting recommendations. LeadingAge NY will be reaching out to the Department of Health (DOH) to determine its position on this question.

What This Means for Members

Members will no doubt be interested in learning whether New York State will be following these new recommendations or enforcing the old ones. We do not yet have a clear answer to that question. The safest course will be to wait for further direction from DOH. However, we note that recent DOH guidance documents (for example, Feb. 4, 2022 Advisory on Healthcare Personnel Return to Work Protocols; May 31, 2022 Revised Isolation and Quarantine Guidance; May 31, 2022 Updated Health Advisory on Infection Prevention and Control Recommendations for Healthcare Personnel; and March 25, 2022 Dear Administrator Letter (DAL) NH 22-09 on Testing and Visitation) have referenced and linked to CDC and CMS guidance. Those links to CDC and CMS guidance now point to the updated guidance documents. We do not know whether DOH intended its guidance to follow all updates to the CDC and CMS guidance.

LeadingAge NY encourages members to read the new guidance in its entirety and reach out to any member of the Policy staff with any questions.

Contact: Amy Nelson, anelson@leadingageny.org, 518-867-8383 ext. 146