CMS has issued a series of updated guidance documents focused on infection control to prevent the spread of COVID-19 in a variety of inpatient and outpatient care settings. The guidance, is based on CDC guidelines and addresses patient triage, screening and treatment, the use of alternate testing and treatment sites and telehealth, drive-through screenings, limiting visitations, cleaning and disinfection guidelines, and staffing. We provide the FAQs for easier access.

If healthcare personnel have been exposed or infected with COVID-19, when can they return to work to prevent staffing shortages?

According to CDC, in hospitals where testing is available, it is suggested that test-based strategies are preferred.

1.Test-based strategy. Personnel should be excluded from work until:

  • Resolution of fever without the use of fever-reducing medications, and
  • Improvement in respiratory symptoms (e.g., cough, shortness of breath), and
  • Negative results of an FDA Emergency Use Authorized molecular assay for COVID-19 from at least two consecutive nasopharyngeal swab specimens collected ≥24hours apart (total of two negative specimens). See Interim Guidelines for Collecting,Handling, and Testing Clinical Specimens for 2019 Novel Coronavirus (2019-nCoV)[www.cdc.gov/coronavirus/2019-ncov/lab/guidelines-clinical-specimens.html].

2. Non-test-based strategy. Personnel should be excluded from work until:

  • At least 3 days (72 hours) have passed since recovery, defined as resolution offever without the use of fever-reducing medications and improvement in respiratorysymptoms (e.g., cough, shortness of breath); and,
  • At least 7 days have passed since symptoms first appeared.

If healthcare personnel were never tested for COVID-19 but have an alternate diagnosis such has having tested positive for influenza, criteria for return to work should be based on existing guidance for that diagnosis.

Are there special considerations for previously exposed or infected healthcare personnel when returning to the workplace?

Before returning to work, exposed healthcare personnel should:

  • Consult with their occupational health program, be monitored for symptoms, and seekre-evaluation from occupational health if fever and/or respiratory symptoms recur orworsen.

For more information on self-monitoring please see https://www.cdc.gov/coronavirus/2019- ncov/hcp/guidance-risk-assesment-hcp.html.

Healthcare personnel with confirmed or suspected COVID-19 should consult with their occupational health program and follow the CDC Interim guidance on return to work.

What additional measures should a hospital, psychiatric hospital, or CAH consider for the mitigation of transmission in outpatient settings?

  • Reschedule non-urgent outpatient visits as necessary.
  • Consider reaching out to patients who may be at a higher risk of COVID-19-related complications such as the elderly, those with medical co-morbidities, and potentially other persons who are at higher risk for complications from respiratory diseases, such as pregnant women to ensure adherence to current medications and therapeutic regimens, confirm they have sufficient medication refills, and provide instructions to notify their provider by phone if they become ill.
  • Consider accelerating the timing of high priority screening and intervention needs for the short-term, in anticipation of the possible need to manage an influx of COVID-19 patients in the weeks to come.
  • Symptomatic patients who need to be seen in a clinical setting should be asked to call before they leave home, so staff are ready to receive them using appropriate infection control practices, including providing a mask for the potentially infectious patient before or immediately upon entry into the healthcare facility, and personal protective equipment for the healthcare personnel.

What additional measures should a hospital, psychiatric hospital or CAH consider for the mitigation of transmission in inpatient settings?

  • Reschedule elective surgeries, procedures, and other visits as necessary. Shift elective urgent inpatient diagnostic and surgical procedures to outpatient settings, when feasible.
  • Maintain social distancing of at least six feet during group therapy interactions.
  • Limit visitors to COVID-19 positive patients and persons under investigation (PUI).
  • Plan for a surge of critically ill patients and identify additional space to care for these patients. Include options for:
    • Using alternate and separate spaces in the ER, ICUs, and other patient care areas to manage known or suspected COVID-19 patients.
    • Separating known or suspected COVID-19 patients from other patients ("cohorting").
    • Identifying dedicated staff to care for COVID-19 patients.

Can an acute care inpatient be admitted to an excluded psychiatric unit to temporarily expand bed capacity?

Yes, CMS will allow acute care hospitals/CAHs with excluded distinct part psychiatric units that need to relocate acute care inpatients to excluded distinct part psychiatric units to provide care for overflow due to COVID-19 patients.

Can an acute care inpatient be admitted to an excluded rehabilitation unit to temporarily expand bed capacity?

Yes, CMS will allow acute care hospitals/CAHs with excluded distinct part inpatient rehabilitation units that need to relocate acute care inpatients to excluded distinct part rehabilitation units in order to provide care for overflow due to COVID-19 patients. The distinct part unit's bed must be appropriate for the acute care inpatient.

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