A. Surveillance and Monitoring of Healthcare Workers
Objective: Establish/adapt
a healthcare personnel surveillance system to ensure that workers who
may have had exposure to SARS-CoV are identified and monitored and
that those who develop illness receive appropriate care.
Activities
- Establish
a process to identify personnel who enter the rooms or units where
SARS patients are provided cared. Possible mechanisms include self-reports,
sign-in sheets, or logs.
- Instruct
personnel who have unprotected contact with patients with SARS-CoV
disease or who have early symptoms of SARS-CoV disease to immediately
notify occupational health, infection control, or a designee.
- Develop
a system to identify healthcare personnel who provided care to a patient
who was later identified as having SARS-CoV disease.
- See
Supplement F, Appendix F6 for guidance on medical surveillance of exposed
laboratory workers.
B. Management of Exposures and Other Contacts with SARS Patients
Objective: Ensure appropriate management and follow-up
monitoring of healthcare workers who have had exposures and other contacts
with SARS patients.
Activities
Clinical
judgment should be used in deciding when a worker has been exposed
and needs follow-up monitoring.
Management of asymptomatic healthcare workers with unprotected high-risk
exposures
An unprotected high-risk exposure occurs when a healthcare worker is
in a room with a SARS patient during an aerosol-generating procedure
or event and the recommended infection control precautions
are either absent or breached. If a healthcare worker has an unprotected
high-risk exposure but has no symptoms of SARS-CoV disease, the worker:
- Should
be excluded from duty (e.g., administrative leave) for 10 days after
the date of the last high-risk exposure.
- Should
be vigilant for the development of fever and/or respiratory symptoms.
- Should
be actively monitored for the development of fever and/or respiratory
symptoms for 10 days after the date of the last high-risk exposure.
Decisions regarding activity restrictions, (e.g., quarantine home/work
restrictions) outside the facility should be discussed with the health
department, in accordance with the recommendations in Supplement
D.
The combination of close monitoring for symptoms and exclusion from
duty protects the hospital and community without imposing unnecessary
restrictions on a healthcare worker.
Management of asymptomatic healthcare workers with unprotected exposures
that are not high risk
Unprotected exposures that are not high risk occur when a healthcare
worker is in a room or patient-care area with a SARS patient (not during
a high-risk procedure) and the recommended infection control precautions
are either absent or breached. If a healthcare worker has an unprotected,
non-high-risk exposure and has no symptoms of SARS-CoV disease, the healthcare
worker:
- Need
not be excluded from duty.
- Should
be vigilant for the development of fever and/or respiratory symptoms
(i.e., measure and record body temperature twice daily for 10 days
following the date of last unprotected exposure, and immediately notify
the healthcare facility if symptoms develop.)
- Should
be actively monitored for the development of fever and lower respiratory
symptoms before reporting to duty.
Decisions regarding activity restrictions, (e.g., quarantine home/work
restrictions) outside the facility should be discussed with the health
department, in accordance with the recommendations in Supplement
D.
Surveillance
of asymptomatic healthcare workers who have cared for
SARS patient(s) but have no known unprotected exposures
- Instruct
workers to be vigilant for the development of fever and/or respiratory
symptoms, measure and record body temperature twice daily throughout
the 10-day period following the date of last protected contact
with a SARS patient, and immediately notify the healthcare facility
if symptoms develop.
- Implement
active follow-up surveillance of these workers for 10 days following
the last protected exposure.
- Decisions
regarding activity restrictions, (e.g., quarantine home/work restrictions)
outside the facility should be discussed with the health department,
in accordance with the recommendations in Supplement
D.
Management
of symptomatic healthcare workers
- Any
healthcare worker who has cared for or been exposed to a SARS patient
and who develops fever and/or respiratory symptom(s) within 10 days
after exposure or patient care should:
- Immediately
contact infection control, occupational health or designee in each
facility where s/he works; and
- Report
to the predetermined location for clinical evaluation. (During periods
of increased SARS activity in the healthcare facility and/or community,
this recommendation extends to all symptomatic personnel working in
the facility, regardless of whether they have had contact with a SARS
patient.)
- Any
healthcare worker who develops symptoms or fever while at work should
immediately put on a surgical mask and notify the appropriate facility
contact (e.g., occupational health, infection control, or other designee)
and then report to the designated location for clinical evaluation.
- Symptomatic
healthcare personnel should be managed in accordance with the recommendations
in Clinical Guidance on the Identification
and Evaluation of Possible SARS-CoV Disease among Persons Presenting
with Community-Acquired Illness.
Decisions on return to work should be guided by policies or regulation
defined by the facility or health department.
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