The Centers for Disease Control and Prevention (CDC) has updated its recommendations for managing health care personnel who are exposed to or infected with common respiratory viruses, including COVID-19, influenza, and RSV.
The new Viral Respiratory Infections guidance establishes a consistent approach to work restrictions and source control. For long term care providers, the most significant change is a shorter minimum work-exclusion period for personnel with COVID-19, and this updated guidance does not include testing as part of the return-to-work criteria.
What Changed
Personnel with a suspected or confirmed viral respiratory infection should remain out of work until:
- At least three days have passed since symptom onset (or from their first positive respiratory virus test if asymptomatic throughout their infection); and
- They have been fever-free for at least 24 hours without fever-reducing medication; and
- Their symptoms are improving; and
- They feel well enough to return to work.
Previously, the CDC generally required personnel with COVID-19 to remain out of work for at least seven days with negative testing or 10 days without testing.
Under this new guidance, the day symptoms begin is day zero, making day four the earliest possible return date. For personnel who test positive but remain asymptomatic, the test date is day zero.
Personnel returning to work should wear source control consistently around residents, coworkers, and visitors until at least the end of day seven. Day eight is the first possible day to work without source control.
Personnel with a known or suspected exposure who remain asymptomatic generally do not need to be excluded from work. They should:
- Wear source control through at least the fifth day after their last exposure;
- Monitor for development of signs or symptoms of a viral respiratory infection for at least five days after their last exposure; and
- Stop working and follow the work-restriction criteria if signs or symptoms develop.
Note: The updated recommendations do not include routine serial testing on days one, three, and five after exposure.
Important Exceptions
The day-four return should not be applied automatically to personnel who were severely or critically ill or are moderately to severely immunocompromised. Return-to-work decisions for these individuals should be made case by case, potentially with expert consultation and pathogen-specific testing.
This recommendation is intended to apply to respiratory viruses such as:
- Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2),
- Influenza,
- Respiratory Syncytial Virus (RSV),
- Parainfluenza,
- Rhinovirus,
- Human Metapneumovirus,
- additional adenoviruses,
- And others.
This recommendation is NOT intended to apply to viral respiratory pathogens addressed in other sections of CDC guidelines (i.e., measles, mumps, rubella, varicella, cytomegalovirus, parvovirus B19, and viral conjunctivitis) or other interim guidance (e.g., for a new or emerging pathogen).
What Members Should Do
Long term care providers should:
Review and update their facility infection prevention & control program, employee-health, exposure-management, and return-to-work policies as pertinent.
Educate staff on the updated guidance, including that day zero is the date of symptom onset or the first positive test; day four is the earliest possible return date, and source control continues at least through day seven.
Maintain testing capabilities because results may still guide treatment, PPE, outbreak response, and resident precautions.
Recognize that resident isolation and Transmission-Based Precautions have not changed as part of this update.
Confirm whether more stringent state or local health department requirements apply.
AHCA regulatory staff understands from CDC that the old COVID-19 specific webpages will be archived soon.
Please send questions to regulatory@ahca.org.