(Editor’s note: We asked Dr. Katherine Schrubbe, RDH, BS, MEd, PhD one of the WDA’s go-to resources for OSHA and compliance matters, to answer a question we frequently receive from WDA members. Last week, Part 1 of this blog series covered protocols for DHCP return to work after testing positive for COVID-19.)
On Jan. 21, the CDC updated the Interim Guidance for Managing Healthcare Personnel with SARS-CoV-2 Infection or Exposure to SARS-CoV-2. Part 1 in this blog series provided current CDC guidance on when dental healthcare personnel (DHCP) with a confirmed COVID-19 infection could return to work safely. This is Part 2, sharing share information on DHCP exposure to COVID-19.
Although daily new cases of COVID-19, as well as COVID-related hospitalizations and deaths, continue to decrease as of this writing, DHCP must continue to follow current guidance to ensure team and patient safety.1 In determining any restrictions, or when DHCP can return-to-work after an exposure to an individual with a confirmed COVID-19 infection, the first thing is to understand what is considered and exposure and close contact. For this guidance, the CDC defines close contact as: a) being within 6 feet of a person with confirmed SARS-CoV-2 infection or b) having unprotected direct contact with infectious secretions or excretions of the person with confirmed SARS-CoV-2 infection.
The CDC considers the duration of a true exposure to be 15 minutes or more (cumulative in a 24-hour period) as prolonged. There are other factors that also play a role, such as correct use of personal protective equipment (PPE), use of well-fitting source control/mask by the individual with SARS-CoV-2 infection, and whether the DHCP and/or the individual with SARS-CoV-2 infection are “up to date”3 with all recommended COVID-19 vaccine doses.2
It is also important to know the difference between a high-risk exposure and a low-risk exposure. Higher-risk exposures generally involve exposure of DHCP’s eyes, nose, or mouth to material potentially containing SARS-CoV-2, particularly if these DHCP were present in the room for an aerosol-generating procedure (AGP).2 According to CDC, an example of a lower-risk exposure is having body contact with the patient (e.g., rolling/touching the patient) without gown or gloves on; this could impart some risk for transmission, particularly if hand hygiene is not performed and DHCP then touch their eyes, nose, or mouth.
It is noteworthy to share, that in general, the CDC states, asymptomatic DHCP who have had a higher-risk exposure do not require work restrictions if they are “up to date”3 with all recommended COVID-19 vaccine doses (including booster) and do not develop symptoms or test positive for SARS-CoV-2.2 However, unless the exposed DHCP has recovered from a COVID-19 infection in the last 90 days, they should still get tested at Day 2 and 5 after their exposure to ensure transmission has not occurred.2
The CDC provides a table to determine DHCP exposure risk and if there are work restrictions.2
The next question becomes, when is the patient, visitor, or other DHCP with a confirmed SARS-CoV-2 infection infectious? According to CDC:
- For individuals who developed symptoms, consider the exposure window to be 2 days before symptom onset through the time when the individual the individual meets criteria for discontinuation of Transmission-Based Precautions for contact tracing (quarantine).4
- For asymptomatic individuals, determining the infectious period can be challenging. If the date of exposure cannot be determined, although the infectious period could be longer, it is reasonable to use a starting point of 2 days prior to the positive test through the time when the individual meets criteria for discontinuation of Transmission-Based Precautions for contact tracing (quarantine).4
In Wisconsin, as of Feb. 22, cases have decreased, but the infectivity activity is still “very high” in 43 of our counties and “high” in the other 29 counties as Omicron is highly transmissible variant.5 Thus, we must remain vigilant in our compliant to current CDC guidance and stay informed on any changes in future guidance.
References:
- Centers for Disease Control and Prevention. Covid-19 Data Tracker Weekly Review. Available at https://www.cdc.gov/coronavirus/2019-ncov/covid-data/covidview/index.html. Accessed February 24, 2022.
- Centers for Disease Control and Prevention. Interim Guidance for Managing Healthcare Personnel with SARS-CoV-2 Infection or Exposure to SARS-CoV-2. Available at: https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-risk-assesment-hcp.html. Accessed February 24, 2022.
- Centers for Disease Control and Prevention. Stay up to date with your vaccines. Available at: https://www.cdc.gov/coronavirus/2019-ncov/vaccines/stay-up-to-date.html. Accessed February 24, 2022.
- Centers for Disease Control and Prevention. Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the Coronavirus Disease 2019 (COVID-19) Pandemic. Available at https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html. Accessed February 24, 2022.
- Wisconsin Department of Health Services. COVID-19: Wisconsin Summary Data. Available at https://www.dhs.wisconsin.gov/covid-19/data.htm. Accessed February 24, 2022.
