CDC, CMS Publish Updated Guidance for Healthcare IP&C in Response to COVID Vaccinations

Posted on April 28, 2021 by Kari Everson

The Centers for Disease Control and Prevention (CDC) published updated infection prevention and control recommendations in response to COVID-19 vaccinations yesterday. Following closely behind the CDC, the Center for Medicare and Medicaid Services (CMS) published two revised memos yesterday as well: QSO 20-38 and QSO 20-39. The QSO memos are revised with the recent CDC guidance updates.

Both the CDC and CMS emphasize the importance of following infection prevention and control recommendations for unvaccinated individuals particularly when caring for immunocompromised residents. The CDC clearly states in these updated recommendations staff PPE practices do remain unchanged. Therefore, universal eye protection and masking should continue in the resident care area.

Testing
Perhaps the biggest change is the revised QSO-20-38-NH testing guidance. Vaccinated staff no longer require routine testing. If a staff member is fully vaccinated for COVID-19 they do not need to be tested in your organization’s surveillance testing unless the organization is in outbreak testing, if they are symptomatic, or have a high-risk exposure. Unvaccinated staff are still required to complete routine testing with frequency based upon the county positivity rate. The county positivity rates and frequencies have not changed from previous practice. Staff who experience a high-risk exposure and residents with prolonged close contact with someone with COVID-19 infection, regardless of vaccination status, should have a series of two viral tests. The first test should be immediately after the exposure is known and again 5-7 days after exposure. 

Testing Staff and Residents after High Risk Exposure. Staff who experience a high-risk exposure and residents with prolonged close contact with someone with COVID-19 infection, regardless of vaccination status, should have a series of two viral tests.  The first test should be immediately after the exposure is known and again 5-7 days after exposure. 

Testing & Symptomatic Individuals.  Anyone, staff or resident, who is symptomatic should be quarantined and tested regardless of vaccination status. 

Testing & COVID + in the Last 90-days. Anyone, staff or resident, who has had COVID-19 in the last 90 days does not require testing if they are asymptomatic, including those with known contact with a COVID positive person.  This can easily be confused with fully vaccinated persons so to review: fully vaccinated persons do need to test during outbreak testing but individuals who have been COVID-19 positive in the last 90-days do not need to participate in outbreak testing.

PPE
While working, staff should continue to wear PPE; however, there are some exceptions to the staff PPE rule for fully vaccinated healthcare workers. Healthcare workers that are fully vaccinated can be together in non-resident care areas such as breakrooms or meeting rooms where they can eat together and have in-person meetings without source control or physical distancing. This changes if there is an unvaccinated staff member in the breakroom, meeting room, or other area. If an unvaccinated staff member is present, then everyone should wear PPE and the unvaccinated staff will need to physically distance from the other staff in the area / room.

Quarantine
Fully vaccinated staff who experience a high-risk exposure and who have no COVID symptoms are not required to be restricted from work for 14-days following the exposure. Residents, however, who experience prolonged close contact with someone should quarantine for 14-days regardless of the resident’s vaccination status. There is some room to relax resident quarantine in situations where there are critical issues such as lack of space, staff or other situations. The CDC reminds us to consult with our local public health and infection prevention experts.

Dining & Activities
For activities and communal dining within our settings, fully vaccinated residents may choose to participate in the activity or eat in the dining room and do not have to wear source control and do not have to socially distance; however, if unvaccinated residents are present, then everyone must wear source control masks and unvaccinated residents are required to socially distance from others.

As we move forward into 2021, guidance continues to evolve as our understanding of SARS-CoV-2 increases. CDC, CMS, and MDH guidance document changes continue to happen at a steady, swift pace which leads to more exceptions and more complicated recommendations. If you have questions or want to discuss your particular situation, please contact Kari Everson, Director of Clinical Care / Nurse Consultant.