Isolation and Quarantine Guidance for Healthcare Workers

These guidelines are specific for healthcare workers, including healthcare workers in long-term care facilities or similar settings.

KDHE defines a healthcare worker as all paid or unpaid persons serving in healthcare settings. This may include, but is not limited to, emergency medical service personnel, nurses, nursing assistants, home healthcare personnel, physicians, technicians, therapists, phlebotomists, pharmacists, dental healthcare personnel, reception, students and trainees, contractual staff not employed by the healthcare facility, and persons not directly involved in patient care, but who could be exposed to infectious agents that can be transmitted in the healthcare setting (ex. environmental services).

Isolation (Test Positive or Have Symptoms after Exposure)

What happens if a healthcare worker tests positive for COVID-19?

Healthcare workers who are asymptomatic or have mild to moderate illness who are not moderately to severely immunocompromised can return to work after the following criteria are met:

At least 7 days have passed since symptoms first appears if a negative viral test (antigen recommended) is obtained within 48 hours prior to returning to work OR 10 days if testing is not performed or if a test is positive at day 5-7 AND
At least 24 hours fever-free without the use of fever reducing medication AND
Symptoms have improved

Healthcare workers with severe to critical illness who are not moderately to severely immunocompromised can return to work after the following criteria are met:

At least 10 days and up to 20 days have passed since symptoms first appeared AND
At least 24 hours fever-free without the use of fever reducing medication AND
Symptoms have improved

Healthcare workers who are moderately to severely immunocompromised should follow a test-based strategy to return to work.

Results are negative from at least two consecutive respiratory specimens collected 48 hours apart (total of two negative specimens) AND
At least 24 hours fever-free without the use of fever reducing medication AND
Symptoms have improved

KDHE and SCHD allow for shorter isolation periods under contingency and crisis staffing levels. Healthcare workers should work with their occupational health to determine appropriate isolation periods for their situation and facility.

Exposure (Close Contact of Someone with COVID-19)

Who is considered a “close contact?”

Exposures that might require testing and/or restriction from work for healthcare workers are considered higher-risk exposures. These can occur at work or in the community.
Higher-risk exposures are classified as a healthcare worker who had prolonged (15 minutes or more over a 24 hour period) close contact (within 6 feet or having direct contact with infectious secretions or excretions) with a patient, visitor, or other person with SARS-CoV-2 infection and:

Healthcare worker was not wearing a respirator (or if wearing a facemask, the person with SARS-CoV-2 infection was not wearing a facemask) OR
Healthcare worker was not wearing eye protection if the person with SARS-CoV-2 was not wearing a facemask OR
Healthcare worker was not wearing all recommended PPE while present in the room for an aerosol-generating procedure.

Higher-risk exposures for a healthcare worker in the community consists of prolonged close contact with someone with SARS-CoV-2 (ex. household contact) and should be managed per the guidelines outlined below.

What happens if a healthcare worker is a close contact of a person with COVID-19?

Following a higher-risk exposure, the healthcare worker should

Have a series of three viral tests

Testing is recommended immediately (but not earlier than 24 hours after the exposure) and, if negative, again 48 hours after the first negative test, and if negative, again 48 hours after the second negative test (typically day 1, day 3, and day 5).
Testing is not recommended for asymptomatic people who have recovered from SARS-CoV-2 infection in the prior 30 days. Testing should be considered for those who have recovered in the prior 31-90 days using an antigen test.

Follow all recommended infection prevention and control practices, including wearing well-fitting source control, monitoring themselves for fever or COVID-19 symptoms, and not reporting to work when ill or if testing positive for SARS-CoV-2 infection.
Any healthcare worker who develops fever or symptoms should immediately self-isolate and be tested.

Work restriction is not necessary for most asymptomatic healthcare workers following a higher-risk exposure, regardless of vaccination status. Examples of when work restriction may be considered include:

Healthcare workers who are unable to be tested or wear source control (well-fitting facemask or respirator) at all times for 10 days following their exposure.
Healthcare workers who are moderately to severely immunocompromised.
Healthcare workers who care for or work on a unit with patients that are moderately to severely immunocompromised.
Healthcare workers who work on a unit experiencing ongoing SARS-CoV-2 transmission that is not controlled (ongoing COVID-19 clusters).

What happens if work restriction is recommended for a healthcare worker after close contact of a person with COVID-19?

The healthcare worker can return to work after either of the following time periods:

After day 7 following the exposure (day 0) if the healthcare worker does not develop symptoms and all viral testing is negative.

Testing is recommended immediately (but not earlier than 24 hours after the exposure) and, if negative, again 48 hours after the first negative test, and if negative, again 48 hours after the second negative test (typically day 1, day 3, and day 5).

If viral testing is not performed, after day 10 following the exposure (day 0) if they do not develop symptoms.

Who determines if the facility is operating in conventional, contingency, or crisis staffing levels?

It is up to the facility to determine if their facility is in conventional, contingency, or crisis staffing. Definitions for each level are provided below.

Conventional Staffing: No anticipated staffing shortages
Contingency Staffing: Staffing shortages are anticipated
Crisis Staffing: Staffing shortages are occurring

Resources for Healthcare Workers

Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the COVID-19 Pandemic (CDC): https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html
Interim Guidance for Managing Healthcare Personnel with SARS-CoV-2 Infection or Exposure to SARS-CoV-2 (CDC): https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-risk-assesment-hcp.html
Strategies to Mitigate Healthcare Personnel Starring Shortages (CDC): https://www.cdc.gov/coronavirus/2019-ncov/hcp/mitigating-staff-shortages.html