CDC updates return to work criteria for healthcare workers
On August 10, the CDC updated the Criteria for Return to Work for Healthcare Personnel with SARS-CoV-2 Infection (Interim Guidance)
in light of accumulating evidence that supports using a symptom-based strategy to ending isolation and precautions for persons with COVID-19. These guidelines were designed for occupational health programs and public health officials making decisions about return to work for healthcare personnel with confirmed SARS-CoV-2 infection, or who have suspected SARS-CoV-2 infection but were never tested.
This most recent update helps guidelines align more closely with the decision memo
, and includes the following major changes:
- For healthcare personnel with severe to critical COVID-19 or who are severely immunocompromised, the recommended duration for work exclusion was changed to at least 10 days and up to 20 days after symptom onset. An added example applying disease severity in determining duration before the return to work can be found here.
- Recommendation to consider consultation with infection control experts.
- Added hematopoietic stem cell or solid organ transplant to severely immunocompromised conditions.
Similar to prior guidelines updates, a test-based strategy is still not recommended (with some exceptions) because this results in excluding healthcare personnel from work who are, in most cases, no longer infectious.
CDC guidelines emphasize that return-to-work decisions should be made in the context of local circumstances.
Pandemic logistics ~ utilizing step-down vs expanding ICU
As the COVID-19 pandemic continues to wreak havoc, hospitals are forced to create logistical solutions to manage during this dynamically changing time. In a recently published manuscript
from the International Journal for Quality in Health Care
, experts found that creating a step-down unit versus expanding their existing ICU assisted with meeting both hospital and patient needs during this pandemic.
According to the manuscript, “We have presented the effects of SDU (step-down unit) creation as a possible solution, taking lessons learned from MCIs, to balance the ratio between inflow and outflow of ICU patients. SDUs played an important role in ICU resistance, allowing supernumerary admissions without compromising the safety and quality of care.”