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ACEP COVID-19 Field Guide

Table of Contents

Safety Practices for Health Care Workers Who May Have Had Exposure to a Person With Suspected or Confirmed COVID-19

Home Safety

Updated April 13, 2020

  • Health care personnel (HCP) with suspected COVID-19 should be prioritized for testing. As part of routine practice, HCP should be asked to regularly monitor themselves for fever and symptoms of COVID-19.
    • HCP should be reminded to stay home when they are ill.
    • If HCP develop fever (T ≥38.0°C [100.4°F]) or symptoms consistent with COVID-19* while at work, they should keep their cloth face covering or face mask on, inform their supervisor, and leave the workplace.
  • All HCP should be screened at the beginning of their shift for fever and symptoms consistent with COVID-19.*
    • Actively take their temperature and document the absence of symptoms consistent with COVID-19.* 
    • If they are ill, have them keep their cloth face covering or face mask on and leave the workplace.

* Fever is either a measured temperature >38.0°C (100.4°F) or a subjective fever. Note that fever may be intermittent or may not be present in some individuals, such as those who are elderly, immunosuppressed, or taking certain medications (eg, NSAIDs). Clinical judgement should be used to guide testing of individuals in such situations. Respiratory symptoms consistent with COVID-19 are cough, shortness of breath, and sore throat. Medical evaluation may be warranted for lower temperatures (<38.0°C [100.4°F]) or other symptoms (eg, muscle aches, nausea, vomiting, diarrhea, abdominal pain, headache, runny nose, fatigue) based on assessment by occupational health.

On April 8, 2020, the CDC updated guidance for “critical infrastructure workers” (which includes health care and public health workers) to “continue work following potential exposure to COVID-19,” if “they remain asymptomatic and additional precautions are implemented to protect them and the community.”

The CDC defines a potential exposure as a household contact or having close contact (within 6 feet) with an infected person for a cumulative total of 15 minutes or more over a 24-hour period* starting from 2 days before illness onset (or, for asymptomatic patients, 2 days prior to test specimen collection) until the time the patient is isolated.

The CDC recommends that workers who have had an exposure but remain asymptomatic adhere to the following practices prior to and during their work shift:

  • Prescreen: The employer should measure the employee’s temperature and assess symptoms prior to the employee starting work. Ideally, temperature checks should happen before the individual enters the facility.
  • Monitor regularly: As long as the employee does not have a temperature or symptoms, the individual should self-monitor under the supervision of the employer’s occupational health program.
  • Wear a mask: The employee should wear a face mask at all times while in the workplace for 14 days after the last exposure. The employer can issue face masks or can approve the employee’s supplied cloth face coverings in the event of shortages.
    • Note: This does not refer to personal protective equipment (PPE) recommended for HCP (see the field guide section on "Appropriate PPE").
  • Practice social distancing: The employee should maintain a 6-foot distance and practice social distancing as work duties permit in the workplace.
  • Disinfect and clean work spaces: Routinely clean and disinfect all areas such as offices, bathrooms, common areas, and shared electronic equipment.

If an employee becomes sick during the day, the individual should be sent home immediately. 

For additional information, see the CDC’s “Implementing Safety Practices for Critical Infrastructure Workers Who May Have Had Exposure to a Person With Suspected or Confirmed COVID-19.”

* Factors to consider when defining close contact include proximity (closer distance likely increases exposure risk), the duration of exposure (longer exposure time likely increases exposure risk), whether the infected individual has symptoms (the period around onset of symptoms is associated with the highest levels of viral shedding), if the infected person was likely to generate respiratory aerosols (e.g., was coughing, singing, shouting), and other environmental factors (crowding, adequacy of ventilation, whether exposure was indoors or outdoors). Because the general public has not received training on proper selection and use of respiratory PPE, such as an N95, the determination of close contact should generally be made irrespective of whether the contact was wearing respiratory PPE.  At this time, differential determination of close contact for those using fabric face coverings is not recommended.

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