Kentucky Mountain Health Alliance, Inc.

1. High and Medium Risk Exposure* Categories

• Any exposure must be reported to the supervisor within 24 hours.
• Work restriction for asymptomatic HCPs who have recovered from SARS-CoV-2 infection in the prior 3 months is not necessary. If staffing shortages occur, it might not be possible to exclude exposed HCPs from work.
• Source Control Measures will be implemented. Please see the Source Control Measures described below.
• HCPs in the high- or medium-risk category should undergo active monitoring and testing (Please see #5).
  • If they develop any fever (measured temperature >100.0F or subjective fever) OR respiratory symptoms consistent with COVID-19, they should immediately self-isolate and notify the MHA healthcare facility promptly so that they can coordinate a plan for further evaluation.

2. Low Risk Exposure* Category

• HCPs in the low-risk category should perform self-monitoring. Asymptomatic HCPs in this category are not restricted from work. They should check their temperature twice daily and remain alert for respiratory symptoms consistent with COVID-19. They should ensure they are afebrile and asymptomatic before leaving home and reporting for work. They may report to work if they do not have a fever or respiratory symptoms. If they develop a fever (measured temperature > 100.0 of or subjective fever) OR respiratory symptoms, they should immediately self-isolate and notify the KMHA healthcare facility promptly so that they can coordinate a plan for further evaluation.

3. HCPs who Adhere to All Recommended Infection Prevention and Control Practices

• Proper adherence to currently recommended infection control practices, including all recommended PPE, should protect HCPs who have prolonged close contact with patients infected with COVID-19. However, to account for any inconsistencies in use or adherence that could result in unrecognized exposures, HCPs should still perform self-monitoring with delegated supervision as described under the low-risk exposure category.

4. No Identifiable Risk Exposure* Category

• HCPs in the no identifiable risk category do not require monitoring or restriction from work.

5. SARS-CoV-2 Testing

• Anyone with symptoms of COVID-19, regardless of their vaccination status, should receive a viral test immediately. A negative result will be confirmed by either a negative NAAT (molecular) or a second negative antigen test taken 48 hours after the first negative test.
• Asymptomatic HCP with a higher-risk exposure and prolonged close contact with someone with SARS-CoV-2 infection, regardless of vaccination status, should have a series of 3 viral tests for SARS-CoV-2 infection. In these situations, testing is recommended immediately and every 48 hours. Following a higher-risk exposure, HCP should have a series of three viral tests for SARS-CoV-2 infection. Testing is recommended immediately (but not earlier than 24 hours after the exposure), and, if negative, again 48 hours after the first negative test, and, if negative, again 48 hours after the second negative test.
  • HCPs with SARS-CoV-2 infection in the last 90 days do not need to be tested if they remain asymptomatic, including those with known contact.
  • Per CDC guidance, the operational definition of “prolonged” refers to a cumulative period of 15 or more minutes during 24 hours, or any exposure should be considered prolonged if it is an aerosol-generating procedure.

6. COVID-19 Infection

KMHA HCPs with the SARS-CoV-2 infection who are well enough and willing to work may return to work as follows:

HCP asymptomatic or with mild to moderate illness who are not moderately to severely immunocompromised:

• At least 5 days have passed since symptoms first appeared (day 0), and
• At least 24 hours have passed since the last fever without the use of fever-reducing medications, and
• Symptoms (e.g., cough, shortness of breath) have improved.
• HCP may choose to confirm the resolution of infection with a negative nucleic acid amplification test (NAAT) or a series of 2 negative antigen tests taken 48 hours apart, with testing starting on day 5 of infection.

If HCPs are requested to return to work before meeting all conventional return-to-work criteria, they will adhere to the recommendations described below.

• HCP will self-monitor for symptoms and seek re-evaluation if symptoms recur or worsen.
• Until they meet the conventional return-to-work criteria:
  • They will wear a respirator or well-fitting facemask at all times, even when they are in non-patient care areas such as break rooms.
  • If they must remove their respirator or well-fitting facemask, for example, to eat or drink, they will separate themselves from others.
  • To the extent possible, they should practice physical distancing from others.
  • Patients (if tolerated) should wear well-fitting source control while interacting with these HCPs.

HCPs with severe to critical illnesses who are not moderately to severely immunocompromised could return to work after the following criteria have been met:

• At least 10 days and up to 20 days have passed since symptoms first appeared, and
• At least 24 hours have passed since the last fever without the use of fever-reducing medications, and
• Symptoms (e.g., cough, shortness of breath) have improved.
• The test-based strategy for moderately to severely immunocompromised HCP may be used to inform the duration of work restriction.
• A negative nucleic acid amplification test (NAAT) or a series of 2 negative antigen tests taken 48 hours apart.

HCPs who are moderately to severely immunocompromised may produce a replication-competent virus beyond 20 days after symptom onset or, for those who were asymptomatic throughout their infection, the date of their first positive viral test.

• Will use a test-based strategy and consultation with an infectious disease specialist or other expert to determine when these HCPs may return to work.

*Test-based strategy

HCPs who are symptomatic could return to work after the following criteria are met:

• Resolution of fever without the use of fever-reducing medications, and
• Improvement in symptoms (e.g., cough, shortness of breath), and
• Results are negative from at least two consecutive respiratory specimens collected 48 hours apart (total of two negative specimens) tested using an antigen test or NAAT.

7. Source Control

Source control is recommended for individuals in healthcare settings who:

• Have suspected or confirmed SARS-CoV-2 infection or other respiratory infection (e.g., those with a runny nose, cough, or sneeze); or
• Had close contact (patients and visitors) or a higher-risk exposure (HCP) with someone with SARS-CoV-2 infection, for 10 days after their exposure.
• HCP asymptomatic or with mild to moderate illness who are not moderately to severely immunocompromised:
  • At least 10 days have passed since symptoms first appeared and
  • At least 24 hours have passed since the last fever without the use of fever-reducing medications
  • Symptoms (e.g., cough, shortness of breath) have improved

Source control options include:

• A NIOSH-approved particulate respirator with N95® filters or higher;
• A respirator approved under standards used in other countries that are similar to NIOSH-approved N95 filtering face piece respirators (Note: These should not be used instead of a NIOSH Approved respirator when respiratory protection is indicated);
• A barrier face covering that meets ASTM F3502-21 requirements, including Workplace Performance and Workplace Performance Plus masks; OR
• A well-fitting facemask.

The Kentucky Mountain Health Alliance, Inc. can be reached during our normal business hours by phone. If you have a medical emergency, please dial 911.

If you have questions about our services, accepted forms of insurance, our facility, or our medical providers, please feel free to contact us during normal business hours by phone or use the form below.