The Centers for Disease Control and Prevention (CDC) have updated their source control recommendations to address limited situations for healthcare facilities in counties with low to moderate community transmission where select fully vaccinated individuals could choose not to wear masks.
CDC reiterates the safest practice is for everyone in a healthcare setting to wear a mask. The guidance includes:
- Updated quarantine recommendations for fully vaccinated patients who have had close contact with someone with SARS-CoV-2 infection to more closely align with recommendations for the community.
- Clarified recommended intervals for testing asymptomatic HCP with a higher-risk exposure and patients with close contact with someone with SARS-CoV-2 infection.
- Added content from previously posted CDC guidance addressing recommendations for fully vaccinated HCP, patients and visitors
- SARS-CoV-2 testing
- Duration of Transmission-Based Precautions for patients with SARS-CoV-2 infection
- Specialized healthcare settings (e.g., dental, dialysis, EMS)
This guidance applies to all U.S. settings where healthcare is delivered, including home health.
In general, healthcare facilities should continue to follow the IPC recommendations for unvaccinated individuals (e.g., use of Transmission-Based Precautions for those that have had close contact to someone with SARS-CoV-2 infection) when caring for fully vaccinated individuals with moderate to severe immunocompromise due to a medical condition or receipt of immunosuppressive medications or treatments.
Employers should be aware that other local, state and federal requirements may apply, including those promulgated by OSHA.
Several of the IPC measures (e.g., use of source control, screening testing) are influenced by levels of SARS-CoV-2 transmission in the community. Two different indicators in CDC’s COVID-19 Data Tracker are used to determine the level of SARS-CoV-2 transmission for the county where the healthcare facility is located. If the two indicators suggest different transmission levels, the higher level is selected.
Recommended routine infection prevention and control (IPC) practices during the COVID-19 pandemic:
- Establish a process to identify and manage individuals with suspected or confirmed SARS-CoV-2 infection.
- Ensure everyone is aware of recommended IPC practices in the facility.
- Post visual alerts (e.g., signs, posters) at the entrance and in strategic places (e.g., waiting areas, elevators, cafeterias) with instructions about current IPC recommendations (e.g., when to use source control and perform hand hygiene). Dating these alerts can help ensure people know that they reflect current recommendations.
- Establish a process to identify anyone entering the facility, regardless of their vaccination status, who has any of the following so that they can be properly managed:
- A positive viral test for SARS-CoV-2
- Symptoms of COVID-19
- Meets criteria for quarantine or exclusion from work
- Options could include (but are not limited to): individual screening on arrival at the facility; or implementing an electronic monitoring system in which individuals can self-report any of the above before entering the facility.
- Healthcare personnel (HCP), even if fully vaccinated, should report any of the 3 above criteria to occupational health or another point of contact designated by the facility.
- Visitors meeting any of the 3 above criteria should generally be restricted from entering the facility until they have met criteria to end isolation or quarantine, respectively.
- Unvaccinated HCP, patients and visitors should be offered resources and counseled about the importance of receiving the COVID-19 vaccine.
Implement Source Control Measures:
Source control refers to use of respirators or well-fitting facemasks or cloth masks to cover a person’s mouth and nose to prevent spread of respiratory secretions when they are breathing, talking, sneezing or coughing.
Source control options for HCP include:
- A NIOSH-approved N95 or equivalent or higher-level respirator OR
- A respirator approved under standards used in other countries that are similar to NIOSH-approved N95 filtering facepiece respirators (note: these should not be used instead of a NIOSH-approved respirator when respiratory protection is indicated) OR
- A well-fitting facemask.
- When used solely for source control, any of the options listed above could be used for an entire shift unless they become soiled, damaged or hard to breathe through. If they are used during the care of patient for which a NIOSH-approved respirator or facemask is indicated for personal protective equipment (PPE) (e.g., NIOSH-approved N95 or equivalent or higher-level respirator during the care of a patient with SARS-CoV-2 infection, facemask during a surgical procedure or during care of a patient on Droplet Precautions), they should be removed and discarded after the patient care encounter and a new one should be donned.
NIOSH-approved N95 or equivalent or higher-level respirators should be used for:
- All aerosol-generating procedures
- All surgical procedures that might pose higher risk for transmission if the patient has COVID-19 (e.g., that generate potentially infectious aerosols or involving anatomic regions where viral loads might be higher, such as the nose and throat, oropharynx, respiratory tract)
- Facilities could consider use of NIOSH-approved N95 or equivalent or higher-level respirators for HCP working in other situations where multiple risk factors for transmission are present.
- Eye protection (i.e., goggles or a face shield that covers the front and sides of the face) should be worn during all patient care encounters.
- Optimize the Use of Engineering Controls and Indoor Air Quality
- Optimize the use of engineering controls to reduce or eliminate exposures by shielding HCP and other patients from infected individuals (e.g., physical barriers at reception / triage locations and dedicated pathways to guide symptomatic patients through waiting rooms and triage areas).
- Perform SARS-CoV-2 Testing
