PIN 21-15-ASC--Updated guidance and direction related to resident cohorting, isolation, quarantine, staffing considerations and use of PPE based on resident COVID-19 status

This PIN supersedes PIN 21-12-ASC and supersedes, in part, PINs 21-17.2-ASC, 21-49-ASC and 20-38-ASC:

• Removes the recommendation that residents who are boosted, OR have completed their primary series but are not yet booster eligible and residents who have recovered from COVID-19 in the prior 90 days be routinely quarantined following an exposure

• Reduces the duration of quarantine for exposed residents who are unvaccinated, or who have completed their primary series and are booster eligible but not yet boosted, from 14 days to 7-10 days

The PIN includes a chart with resident isolation and cohorting and staffing considerations by resident COVID-19 status:

Utilize cohorts to the extent possible:

• “Red” Area: COVID-19 positive residents under isolation

• “Yellow-Person Under Investigation (PUI)” Area: Symptomatic residents, suspected COVID-19, and awaiting test results

• “Yellow-Exposed Status” Area: Residents who are unvaccinated, or who have completed their primary series and are booster eligible but not yet boosted, and had close contact (meaning within six (6) feet for a cumulative total of 15 minutes or more over a 24-hour period) with a person who is COVID-19 positive.

• “Yellow-Observation Status” Area: Newly admitted or re-admitted residents under observation

• “Green” Area: Residents with no known exposure within the last 14 days; who had a COVID-19 diagnosis in the last 90 days that have fully recovered and are now asymptomatic; and exposed asymptomatic who are boosted, or have completed their primary series but are not yet booster eligible, and not required to quarantine.

Use “Red”, “Yellow”, and “Green” cohort areas/status to assist with managing residents with a particular COVID-19 status, but residents do not need to be physically moved between different areas of the community if their COVID-19 status changes if they can be appropriately isolated or quarantined in place. Consult with local health department if they have different or stricter guidance for resident placement. Consider proactively creating “groups” of residents for staggered communal dining or group activities when there is no outbreak.

Caring for Residents in Isolation or Quarantine

Staff should check the resident’s general appearance to determine any signs of distress and check the resident for symptoms consistent with COVID-19 in order to quickly detect deterioration in status as often as needed. Notify the resident’s health care provider and their representative if the resident’s condition worsens or changes. If care needs include the need for oxygen, adhere to the statutes and regulations related to oxygen administration prior to caring for any such residents.

Duration of Isolation for COVID-19 Positive Residents

Regardless of vaccination status, any resident that tested positive for COVID-19 must isolate until they:

• Have been cleared by the local health department; or

• Meet the conditions to discontinue isolation:

Residents who test positive and are symptomatic:

o At least 24 hours has passed since recovering, defined as resolution of fever without the use of fever-reducing medications AND

o Resolution in respiratory symptoms (e.g., cough and shortness of breath) AND

o At least 10 days have passed since symptoms first appeared.

Residents who test positive and are asymptomatic:

o 10 days from the date of their positive test, as long as they have not subsequently developed symptoms, in which case the symptoms-based criteria above for discontinuing isolation should be applied.

Appendix A has a supplemental table on the duration of isolation

Duration of Quarantine for Residents Exposed to COVID-19

Residents who are boosted, or have completed their primary series but are not yet booster eligible, and residents who have had COVID-19 in the prior 90 days, who have had close contact with someone with COVID-19 infection and remain asymptomatic do not need to be quarantined, restricted to their room, or cared for by staff using the full PPE recommended for the care of a resident with COVID-19 infection unless they develop symptoms of COVID-19, are diagnosed with COVID-19, or the facility is directed to do so by the local health department. Quarantine might be considered following an exposure for residents who are moderately to severely immunocompromised, or there is a widespread outbreak, even if the resident is boosted. Contact the local health department for consultation if there is a need to quarantine these residents.

Asymptomatic residents with close contact with someone with COVID-19, regardless of vaccination status, should have a series of two tests for COVID-19. In these situations, testing is recommended not earlier than 2 days after the exposure and, if negative, again 5–7 days after the exposure. Testing is not generally recommended for people who have had COVID-19 in the last 90 days if they remain asymptomatic.

Residents who are unvaccinated, or who have completed their primary series and are booster eligible but not yet boosted, and who have had close contact with someone with COVID-19 should be placed in quarantine after their exposure, even if viral testing is negative.

• Residents can come out of quarantine after day 7 following the exposure (day 0) if a viral test is negative for COVID-19 and they do not develop symptoms. The specimen should be collected and tested within 48 hours before the time of planned discontinuation of quarantine.

• Residents who are not tested again can come out of quarantine after day 10 following the exposure if they do not develop symptoms. Consider testing for COVID-19 within 48 hours before the time of planned discontinuation of quarantine.

Appendix B has a supplemental table on the duration of quarantine

Staffing Considerations and Shortages

When possible, designate certain staff to care for residents who are COVID-19 positive (“red” area), and different staff to care for residents of other cohorts. Ideally, staff caring for residents who are COVID-19 positive should have a separate restroom and breakroom to ensure they are not interacting with staff dedicated to caring for non-COVID positive residents.

A facility must have enough staff to meet resident needs at all times and should have a plan ready to implement in the event of a staffing shortage as part of their existing COVID-19 Mitigation Plan (until the community submits their new Infection Control Plan to CCLD).

N95 Respirators and Face Masks

PIN 21-38-ASC has information about masking requirements, including the use of N95s, for staff, and masking guidance for residents.

CCLD provided information on Cal/OSHA respiratory protection requirements in PIN 21-38-ASC and PIN 21-09-ASC and respirator fit testing in PIN 21-10-ASC.

Place signage in the community on proper PPE donning and doffing and how to perform a seal check.

Continuing Care Retirement Communities (CCRC)

Independent CCRC residents are generally exempt from testing, quarantine, and isolation guidelines, and visitation restrictions except when the independent CCRC resident is:

• living with a resident who is receiving assisted living services;

• commingling with residents who receive assisted living services or live in assisted living units by, for example, participating in communal dining or activities or using common facility amenities;

• presenting symptoms for COVID-19;

• exposed to a person who tested positive for COVID-19;

• moving into the facility; or

• returning from being treated at a hospital or higher level of care facility.

An independent CCRC resident who is not exempt as listed above, may be subject to the testing, quarantine, and isolation guidelines, and visitation restrictions applied to RCFE residents.

Cal/OSHA has removed their interim guidance that allowed certain strategies to extend the supplies of respirators. Pursuant to Title 8, communities must use respirators in full accordance with manufacturers’ instructions and their NIOSH approval. Extended use may be implemented for facemasks or N95 respirators only when used for source control and discarded when they become soiled, damaged or hard to breathe through.

CDPH and CDC recommend eye protection for all direct resident care, and N95 respirator while caring for residents undergoing Aerosol Generating Procedures in the Green Area during an outbreak or in counties with substantial or high community transmission rates per the CDC tracking website. Eye protection should always be worn per standard precautions when performing tasks that could generate splashes or sprays of blood, body fluids, secretions and excretions.

Extended use and reuse of gowns should be avoided if possible.

Clearpol Inc. does not make any guarantees regarding the accuracy of the opinions provided on our platform. Please use your own judgement.