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Healthcare Provider Exposure

Posted/Updated on 4/3/20 4:15 PM

As the number of COVID-19 cases increase, the potential for healthcare workers to be exposed increases as well.  As healthcare workers identify themselves as having been exposed or potentially exposed, the need to respond quickly will be paramount to minimizing additional exposure. While the ultimate goal is prevention of exposure, there may be circumstances out of your control. Preparation for potential exposure is recommended. Such measures may include contingent staffing plans in preparation for absences, as well as awareness of notification requirements to health officials, patients and co-workers.

How to minimize Exposure to COVID-19

Healthcare personnel (HCP) caring for patients with confirmed or possible COVID-19 should adhere to CDC recommendations for infection prevention and control (IPC):

  • Post visual alerts (e.g., signs, posters) at the entrance and in strategic places (e.g., waiting areas, elevators, cafeterias) to provide patients and HCP with instructions.

  • Assess and triage these patients with acute respiratory symptoms and risk factors for COVID-19 to minimize chances of exposure, including placing a respirator or facemask on the patient and placing them in an examination room with the door closed.

  • Use Standard and Transmission-Based Precautions when caring for patients with confirmed or possible COVID-19.

  • Perform hand hygiene with alcohol-based hand rub before and after all patient contact, contact with potentially infectious material, and before putting on and upon removal of PPE, including gloves. Use soap and water if hands are visibly soiled.

  • Properly don, use, and doff PPE in a manner to prevent self-contamination.

  • Perform aerosol-generating procedures, in an airborne infection isolation room (AIIR), while following appropriate IPC practices, including use of appropriate PPE.

  • Adhere to currently recommended IPC practices, including all recommended PPE to protect against prolonged close contact with patients infected with COVID-19.

Guidance for HCP with Potential Exposure to Coronavirus Disease (COVID-19)

The CDC provides guidance on work restrictions for asymptomatic HCP depending on “Exposure Risk Category.” A table is provided to aid organizations in characterizing risk as well as monitoring recommendations and work restriction. The site also provides guidance on post-exposure management for healthcare providers.

  • Please refer to CDC for comprehensive definitions and the most up to date detail regarding this table. Interim Guidance may changes as the situation evolves.

  • Clinicians caring for HCP with suspected COVID-19 should follow CDC’s Criteria for Evaluation and Laboratory Testing for COVID-19, which instructs immediate notification of the local or state health department.
    • For healthcare personnel, testing may be considered if there has been exposure to a person with suspected COVID-19 without laboratory confirmation. Because of their often extensive and close contact with vulnerable patients in healthcare settings, even mild signs and symptoms (e.g., sore throat) of COVID-19 should be evaluated among potentially exposed healthcare personnel.

    • Upon reporting an HCP as a Person Under Investigation (PUI), State health departments should complete a PUI and Case Report form as directed by the CDC. This form was designed to collect key information on PUIs, presumptive positive cases, and laboratory-confirmed COVID-19 case-patients to track the impact of the outbreak and inform public health response. This form does ask if the patient is a healthcare worker in the United States.

Planning for potential absences

Planning for the possibility that you or your staff may require time off from work in these uncertain times is advisable. Having contingency plans in place will help ensure continuity of care for patients with active treatment plans for acute or chronic medical conditions and will serve to mitigate potential risks to you and your practice. Here are few tips and recommendations for your consideration.

  • Consider alternative clinician support for the long-term (e.g., locum tenens, PA or NP) to cover absences.

    • What have your plans been in the past with respect to extended vacations/emergency sick or family leave? Are any of those plans and resources a possibility currently or in the event of an unexpected closure or absence?

    • Consider reaching out to colleagues of your same speciality in your community or neighboring communities to discuss various options to cover one another.
  • Connect with your local Health Department officials. Do they have local guidance and/or resources for you and your practice?

  • Contact your local medical society for available resources.

  • Notify your patients of your absence and interim measures in place:
    • Consider signage at your office, on your website, and via voicemail message if applicable.
    • Call and/or send letters to active patients; especially those with appointments in the near future. Reschedule well visits as applicable.
    • Consider notifying patients with serious medical conditions or who need close follow-up by certified mail, return receipt requested if unable to reach by phone.
    • Document all conversations and letters in the patient record.
  • If you have contracts with managed care plans, review them for any requirements to inform the plans of your absence.

  • Promptly provide patients and/or their subsequent treating physicians with their medical records upon request.

  • If your practice has not considered telehealth visits to this point, it is recommended that you explore the requirements and feasibility as applicable to your speciality and care setting before the need becomes urgent or emergent. If you experience moderate or high-risk exposure—or test positive for COVID-19 but have mild or no symptoms—there may be an opportunity to conduct telehealth visits for some patients in lieu of all visits being diverted to other colleagues and practices.

Returning to work after exposure to COVID-19

Once a healthcare provider has been identified as having been exposed to COVID-19 and is confirmed to or believe to have contracted the virus, organizations need to plan for their return to work caring for patients. Interim guidance has been provided by the Centers for Disease Control and Prevention (CDC).


Topics: COVID-19