The California Department of Health has issued a new All Facilities Letter (AFL 20-74.1) providing updated recommendations for Personal Protective Equipment (PPE), resident placement/movement, and staffing in skilled nursing facilities based on residents' COVID-19 status. The letter clarifies when eye protection must be used and aligns with the latest CalOSHA requirements, which no longer allow extended use and reuse of respirators. Facilities should group residents into three separate cohorts: COVID-19 positive, COVID-19 exposed within the last 14 days, and COVID-19 negative without known exposure within the last 14 days or recovered residents who have completed their isolation period. The COVID-19 positive cohort should be housed in a separate "red area" with dedicated healthcare personnel. Private rooms should be prioritized for new admissions and symptomatic residents. The color-designations define residents' exposure status and the necessary PPE for healthcare personnel. Facilities should contact the Healthcare-Associated Infections Program with any questions about the AFL.

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