Risk assessment and management of health care workers exposed to COVID-19 patients

This guidance provides provincially standardized exposure criteria to assess risk for health care workers exposed to COVID-19 patients while at work. It aims to support health authorities and the Provincial Workplace Health Call Centre (PWHCC) to effectively screen and manage health care workers exposure and provides recommendations for appropriate measures based on exposure risk level.

• Recommendations for risk assessment and management of health care worker exposures to COVID-19 patients

The guidance is summarized in the BC Health Care Worker COVID-19 Exposures Risk Assessment Tool:

• Download a copy of the assessment tool (PDF)

Who to screen

All HCWs who have been in close contact with a confirmed COVID-19 patient while providing direct patient care without consistent and appropriate Personal Protective Equipment (PPE) as per the COVID-19 PPE Allocation Framework.

Factors Influencing Exposure Risk:

The following list of factors (not exhaustive) should be considered by Workplace Health and Safety (WHS), Infection Prevention and Control  and/or Public Health when conducting case-by-base risk assessments, as they can increase or decrease the level of risk in a given exposure scenario:

• Duration of exposure (exposure time longer than 15 minutes can increase risk, brief interactions may have lower risk).
• Type of interaction (a patient interview has lower risk than a cough-inducing procedure).
• Extent of body contact (contact with infectious body fluids, particularly oral and respiratory secretions can increase risk).
• Clinical presentations of patient symptoms (coughing and severe illness can increase risk).
• Patient wearing a mask properly for the entirety of the interaction (can lower risk).
• HCW not following proper practices of donning (putting on) and doffing (taking off) PPE [see BCCDC posters].
• HCW not performing diligent hand hygiene.
• PPE was soiled, damp, damaged or inconsistently worn (can increase risk).
• Other individual and context-based factors.
  

Return to work for health care workers with symptoms

Guidance is available for Workplace Health and Safety, Public Health staff and Medical Health Officers to support decision-making on return to work for health care workers with symptoms of COVID-19.  This includes health care workers with confirmed COVID-19, HCWs that developed symptoms following exposure to confirmed cases of COVID-19, and suspected cases of COVID-19.

The guidance includes information on

• the criteria for return to work,
• self-isolation for staff with travel history outside Canada,
• earlier return to work to maintain base staffing levels, and
• additional precautions including mask usage, restricting access to severely immunocompromised patients and infection prevention and control measures.

• Interim guidance on return to work for health care workers with symptoms of COVID-19

The Health Care Worker Return to Work Decision Tree summarizes the guidance and can be used as a tool to support decision-making.

• Download a copy of the decision tree

The decision to discontinue self-isolation for health care workers should be made in consultation with Workplace Health and Safety, Public Health staff and the Medical Health Officer, based on the potential risk of transmission to others.  Factors to be considered include:

• Severity and length of the illness.
• Close contact with vulnerable populations (e.g., infants, seniors, immunocompromised).
• Feasibility of getting tested.
• Individual factors (e.g., pediatric and immunocompromised individuals may shed for longer).
• Potential risk of understaffing in health care facilities.
• Other situation and local context-specific factors.