Nov 2022

With recent changes to Washington State Department of Health guidance, we wanted to provide you with information on which COVID-19 procedures have and haven’t changed for healthcare facilities. 

Who is a Healthcare Facility?

• All long-term care settings that previously were considered healthcare facilities are still considered healthcare locations and must follow healthcare guidance (includes Assisted Living, Supported Living, Certified Community Residential Services and Support Providers, Enhanced Services).

Community Transmission Levels:

• CDC COVID tracker – this link takes you to the Whatcom County data tracker & automatically shows community transmission levels, the metric used for healthcare guidance. These metrics are updated weekly on Thursdays. Facilities should check the new county levels on Thursdays, no need to check more than once a week.

• When community transmission levels go from substantial à high, additional interventions should be implemented immediately. When community transmission levels change from high à anything lower, interventions implemented during “high” levels should remain in place until community transmission has remained below the “high” threshold for 14 days. On the 15th day you can stop using additional interventions.

Source Control:

• No change, universal source control remains required for everyone in and entering healthcare settings under Secretary of Health order even though Governor emergency proclamations have expired.
• Staff should wear source control everywhere including in breakrooms and other spaces where co-workers may be present

Eye Protection:

• Eye protection is recommended for all patient/resident encounters in high transmission regions.
• Use the CDC COVID tracker and ensure you are looking at community transmission levels, not community levels. Eye protection is no longer necessary when transmission levels are substantial, only when high.

Aerosol-generating Procedures (AGPs):

• During AGP: Respirator + Personal Protective Equipment (PPE)
  • In high community transmission locations, wear all transmission-based precautions (TBP) PPE including a respirator
• After AGP: Respirator + PPE Use
  • In high transmission areas, keep doors closed and wear all TBP PPE including respirator for 3 hours following AGP (or clearance rate if known). Healthcare providers may be exempt from respirator use if they meet all criteria.

Testing of Staff and Residents:

• Routine Staff Testing
  • Screening testing of asymptomatic staff is not required and is at the discretion of the facility
• Symptomatic testing
  • Healthcare providers and patients should be tested immediately if symptomatic, regardless of vaccination status or previous infection. DOH defers to CDC for testing frequency of symptomatic individuals. CDC: " One confirmatory NAAT (PCR) test. Test again if negative, but high level of suspicion. Or one antigen test and one confirmatory NAAT. Or 2 antigen tests spaced 48 hours apart.
  • * Use antigen tests for those with COVID infection within the last 90 days
• Asymptomatic and Exposed
  • No previous COVID infection: healthcare providers and patients should be tested 24 hours after exposure, and again on day 3 and day 5 (with day 0 being date of exposure) = [day 1, day 3, day 5]
  • Previous COVID infection: Infection in the last 30 days and asymptomatic = no testing needed; Infection in last 30-90 days = test using antigen test
• Outbreak/Post-Exposure facility testing:
  • No change: If unit or facility wide, test every 3-4 days until there have been no new positives for 14 days. Work with [email protected] to develop a response plan

Screening/Monitoring Staff, Visitors, and Residents:

• Staff
  • Screening not required. Watch for symptoms and follow facility sick policy
• Visitors
  • Screening not required, encourage visitors to watch for symptoms and have process of communicating visitation timeline. Encourage visitors to delay a visit if they are positive, have exposure or symptoms.
  • 10-day healthcare timeline for deferring visitation if criteria is met (positive test, symptoms, exposure).
• Residents
  • No resident monitoring requirement set out by DOH. Watch for COVID symptoms and may do monitoring to check on symptoms, follow care plan

Staff Return to Work After Infection or Exposure:

• Not based on vaccination status
• Restriction from work after HCP is exposed is generally not recommended. However, post-exposure series of 3 tests needed (on days 1, 3, and 5 after exposure)

Quarantine Criteria for Residents:

• Empiric transmission-based precautions (quarantine) are not generally recommended for asymptomatic and exposed.
• Quarantine when exposed resident:
  • is unable to be tested or wear source control as recommended for the 10 days following their exposure
  • is moderately to severely immunocompromised
  • is residing on a unit with others who are moderately to severely immunocompromised
  • is residing on a unit experiencing ongoing SARS-CoV-2 transmission that is not controlled with initial interventions

Quarantine and Isolation Timeframes for Residents:

• No change to isolation timeline – should be the full 10 days for residents
• Quarantine timeline is still the same number of days however testing is now a series of 3 tests, spaced 48 hours apart

Resident Admissions and Leaving the Facility:

• Skilled nursing facilities must test admissions when community transmission is high, screening new admissions during lower community transmission levels is at the discretion of the facility.
• Admissions generally do not need to be quarantined unless they meet quarantine criteria as described in quarantine section above.
• People should not be denied admission because of a potential positive status. The facility should provide a private room and appropriate staffing to finish the isolation period of 10 days.