Heath care workers (HCW) and travel is a topic that continues to elicit questions because of the complexity and multivariate nature of the guidance. Current guidance from the Minnesota Department of Health recommends abstaining from travel due to the pandemic. If HCWs decide to travel, you should consider the following information as you create organizational protocols that best address your expectations regarding travel to keep staff and residents safe.

The current Minnesota Department of Health (MDH) guidance strongly recommends a 14-day self-quarantine after HCWs who choose to travel out of state. This recommendation does not apply to those who must cross state or country boarders for:

• Work
• Study
• Medical Care
• Personal Safety and Security

The recommendation is the same regardless of whether or not a HCW is fully vaccinated.

There are instances where staffing is difficult and organizations can consider bringing HCW back to work who have not completed the 14-day quarantine, have not tested positive for COVID-19, and do not have symptoms of COVID-19. In these instances, the HCW should wear a medical-grade facemask for source control at all times within the facility. If, at any time, the HCW develops symptoms consistent with COVID-19, they should be immediately quarantined and excluded from work until they meet the return-to-work criteria. In the most recent guidance published on Feb. 23, MDH lists out standards for bringing HCWs back to work after they have experienced a high-risk exposure.

The CDC and MDH continue to recommend quarantine after travel. Many organizations have staff that are planning trips and going on vacations despite the recommendations to refrain from travel. Questions continue to pour in about what organizations can do in these circumstances. LeadingAge Minnesota discussed this with MDH and asked, specifically, if a survey citation would be issued if they did not quarantine health care workers after travel. MDH indicated they are not currently issuing regulatory deficiencies specifically for having a plan other than a 14-day quarantine after travel. However, there continues instance in which citations could be given based upon a lack of protocol for quarantine after travel, returning staff to work in a staffing crisis, etc. We recommend members review the MDH guidance documents and the CDC guidelines and use these items to create protocols that fit the decisions made by your organization regarding staff travel and quarantine.

Best practice continues to be quarantine; however, MDH does give more information on how to take a safer approach when returning HCWs to work without a post-travel quarantine. If you choose not to require a HCW to quarantine after travel, MDH lists the following suggested interventions:

• HCWs who have had a high-risk exposure and return to work during quarantine should be proactively tested post-exposure (for example: testing on days 3, 5, 7, 10, and 12). Specific testing protocols are dependent on the health care facility testing capacity and turnaround time. At a minimum, MDH recommends that exposed HCWs who work during the 14-day quarantine period be tested at approximately day 5–7 and day 10–12 following the date of the high-risk exposure.
• HCWs should consider a mid-shift self-assessment for signs and symptoms of COVID-19 while working during quarantine.
• Facilities should increase audits for PPE, hand hygiene, activity in breakrooms and lunchrooms and limit the number of HCW in breakrooms to ensure social distancing. HCWs working during a quarantine period should take breaks alone in the breakroom, if possible.

MDH further lists interventions organizations should implement including review and education of these interventions with HCWs who return to work without a 14-day quarantine after travel. If it remains necessary for the HCW to provide direct patient care during the quarantine period, the HCW should:

• Avoid seeing high-risk patients (e.g., older adults, immunocompromised people, and those with co-morbidities), if possible.
• Practice diligent hand hygiene and wear a medical-grade facemask at all times.
• Avoid sharing breakroom or lunchroom with co-workers.
• Monitor themselves closely for any symptoms associated with COVID-19 (e.g., measured or subjective fever, cough, shortness of breath, chills, headache, muscle pain, sore throat, or loss of taste or smell), and measure body temperature daily before going to work.
• Remain at home and notify their supervisor if they develop respiratory symptoms OR have a measured body temperature of greater than 100 degrees Fahrenheit.
• If at work when fever or respiratory symptoms develop, immediately notify their supervisor and go home.
• Notify their supervisor of other symptoms (e.g., fever greater than 100 degrees Fahrenheit, nausea, vomiting, diarrhea, abdominal pain, runny nose, fatigue), as medical evaluation may be recommended.

However you choose to handle staff who are returning from travel, it is important your organization’s policy matches your practice and includes all of the necessary information on additional approaches such as testing, staff education, and monitoring.

If you have questions, or would like to discuss your specific situation, please contact Kari Everson – keverson@leadingagemn.org.

Related Guidance Documents & Information:

MDH: Clarification of Staffing Options for Congregate Care Facilities Experiencing Staffing Shortages
CDC:   Criteria for Return to Work for Healthcare Personnel with SARS-CoV-2 Infection
MDH: Quarantine Guidance for COVID-19
CDC: Interim Clinical Considerations for Use of mRNA COVID-19 vaccines Currently Authorized in the U.S.
CDC:  Know Your Travel Risk
MDH: Protect yourself & Others: COVID-19: Traveling
CDC: Post Vaccine Considerations for Healthcare Personnel