(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. Next week, Part 2 of this blog series will cover protocols for DHCP exposure to COVID-19.)
Keeping up with the CDC changes is a full-time job – and ensuring that correct guidelines are followed can be an even greater challenge. Let’s look at what has changed since the new year to answer this question.
On Jan. 16, the CDC updated the definition on when individuals are “up to date” with their COVID-19 vaccines, and that has an impact on the course of action for healthcare personnel (HCP) who may be exposed to COVID-19. Up to date means a person has received all recommended COVID-19 vaccines, including any booster dose(s) when eligible. Fully vaccinated means a person has received their primary series of COVID-19 vaccines.1
Based on the above information, on Jan. 21, the CDC then updated the Interim Guidance for Managing Healthcare Personnel with SARS-CoV-2 Infection or Exposure to SARS-CoV-2.2 It is important to remember that dental healthcare personnel (DHCP) must follow healthcare guidance, not the CDC guidance set for the general public on Quarantine and Isolation.3 Also, the CDC has archived the specific Guidance for Dental Settings; Interim Infection Prevention and Control Guidance for Dental Settings During the Coronavirus Disease 2019 (COVID-19) Pandemic4 and has now included dentistry in the general healthcare guidance, Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the Coronavirus Disease 2019 (COVID-19) Pandemic that was updated on Feb. 2.5 . There is no longer separate guidance for dental settings.
Included in the CDC’s updated guidance is a chart that provides return-to-work strategies for HCP who have COVID-19 infections, as well as those who have been exposed to COVID-19.
The chart shows different standards (or strategies) for when HCP can return to work, listed as “conventional, contingency or crisis.” The CDC states, “this guidance was updated to enhance protection for HCP, patients, and visitors, and to address concerns about potential impacts on the healthcare system given a surge of SARS-CoV-2 infections”.2
It is important to note that dental settings do not fall into the “contingency” or “crisis” column strategies as these relate to Strategies to Mitigate Healthcare Personnel Staffing Shortages.6
The “crisis” and “contingency” columns, which include protocols to use when there are no longer enough staff to safely provide patient care, are directed primarily toward large medical facilities. Therefore, dental practices should follow the “conventional” column strategy to determine when DHCP can return to work.
The following are criteria to determine when dental HCP with SARS-CoV-2 infection could return to work2.
DHCP with mild to moderate illness who are not moderately to severely immunocompromised:
- At least 7 days if a negative antigen or NAAT (nucleic acid amplification test/PCR test) is obtained within 48 hours prior to returning to work; (OR 10 days if testing is not performed or if a positive test at day 5-7) have passed since symptoms first appeared, and
- At least 24 hours have passed since last fever without the use of fever-reducing medications, and
- Symptoms (e.g., cough, shortness of breath) have improved.
DHCP who were asymptomatic throughout their infection and are not moderately to severely immunocompromised:
- At least 7 days if a negative antigen or NAAT is obtained within 48 hours prior to returning to work (or 10 days if testing is not performed or a positive test at day 5-7) have passed since the date of their first positive viral test.
DHCP with severe to critical illness and are not moderately to severely immunocompromised:
- At least 10 days and up to 20 days have passed since symptoms first appeared, and
- At least 24 hours have passed since last fever without the use of fever-reducing medications, and
- Symptoms (e.g., cough, shortness of breath) have improved.
- The test-based strategy as described for moderately to severely immunocompromised HCP below can be used to inform the duration of isolation.
DHCP who are moderately to severely immunocompromised may produce replication-competent virus beyond 20 days after symptom onset or, for those who were asymptomatic throughout their infection, the date of their first positive viral test. Use of a test-based strategy and consultation with an infectious disease specialist or other expert and an occupational health specialist is recommended to determine when these HCP may return to work.
The Interim Guidance for Managing Healthcare Personnel with SARS-CoV-2 Infection or Exposure to SARS-CoV-22 also provides guidance on how to manage DHCP exposure to COVID-19 as well and provides an excellent resource that dental management teams should become familiar with to ensure team and patient safety. Part 2 in this blog series will discuss protocols related to DHCP exposure to COVID-19.
References:
- Stay up to date with your vaccines. Accessed February 7, 2022. Available at: https://www.cdc.gov/coronavirus/2019-ncov/vaccines/stay-up-to-date.html
- Interim Guidance for Managing Healthcare Personnel with SARS-CoV-2 Infection or Exposure to SARS-CoV-2. Accessed February 7, 2022. Available at: https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-risk-assesment-hcp.html
- Quarantine and Isolation. Accessed February 7, 2022. Available at: https://www.cdc.gov/coronavirus/2019-ncov/your-health/quarantine-isolation.html
- Guidance for Dental Settings; Interim Infection Prevention and Control Guidance for Dental Settings During the Coronavirus Disease 2019 (COVID-19) Pandemic. Accessed February 8, 2022. Available at: https://www.cdc.gov/coronavirus/2019-ncov/hcp/dental-settings.html
- Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the Coronavirus Disease 2019 (COVID-19) Pandemic. Accessed February 14, 2022. Available at https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html
- Strategies to Mitigate Healthcare Personnel Staffing Shortages. Accessed February 7, 2022. Available at: https://www.cdc.gov/coronavirus/2019-ncov/hcp/mitigating-staff-shortages.html
