AFL 20-88 From the California Department of Public Health
November 25, 2020
TO: General Acute Care Hospitals
SUBJECT: Coronavirus Disease 2019 (COVID-19) Testing Recommendations for Patients and Health Care Personnel (HCP) at General Acute Care Hospitals (GACHs)
All Facilities Letter (AFL) Summary
This AFL provides guidance for weekly SARS-CoV-2 screening testing for HCP and recommendations for the testing of newly admitted patients.
General Testing Guidance
GACHs continue to be significantly affected by COVID-19, requiring ongoing efforts to prevent COVID-19 exposures and transmission among HCP and patients within these facilities. HCP working in hospitals located in areas with elevated community transmission are at higher risk for SARS-CoV-2 exposures both in the community and in their workplace, particularly when the hospital is experiencing a surge of COVID-19 cases. Infected HCP can transmit to other HCP (through close contact in break rooms and other common areas) as well as their patients in health facilities, including hospitals. The California Department of Public Health (CDPH) recommends GACHs include testing strategies informed by the Centers for Disease Control and Prevention (CDC) recommendations, which include:
- TestingHCP with signs or symptoms consistent with COVID-19
- Testing asymptomatic HCP with known or suspected exposure to SARS-CoV-2
- Testing asymptomatic HCP without known or suspected exposure to SARS-CoV-2 for early identification
Routine SARS-CoV-2 screening testing of hospital HCP may aid in early identification and work exclusion of infected HCP, reduce transmission risk to other HCP and patients, and prevent hospital outbreaks.
GACHs must understand that routine SARS-CoV-2 screening testing of HCP does not replace or preclude other infection prevention and control interventions, including monitoring all HCP and patients for signs and symptoms of COVID-19, universal masking by HCP and patients for source control, maintaining physical distancing and source control in HCP common areas (e.g., breakrooms), use of recommended personal protective equipment (PPE), and environmental cleaning and disinfection. When testing is performed, a negative test only indicates an individual did not have detectable infection at the time of testing; individuals might have SARS-CoV-2 infection that is still in the incubation period or could have ongoing or future exposures that lead to infection.
HCP Screening Testing
CDPH strongly recommends GACHs implement a program of weekly screening testing for SARS-CoV-2 for HCP. All HCP should be included in the weekly screening testing program to maximize the strategy for prevention of outbreaks. While initially developing capacity and procedures for implementing a hospital-wide HCP testing program, hospitals may initially prioritize weekly screening testing the week of December 7th in HCP in the following high-risk categories:
- HCP whose work carries a higher risk of SARS-CoV-2 exposure to patients with unknown COVID-19 status, e.g., HCP who work in emergency departments or intensive care units where aerosol generating procedures might be performed urgently; testing should include all workers who provide patient care or perform other duties (e.g., environmental cleaning) on these units and not be limited to assigned staff
Hospitals should submit the General Acute Care Hospital COVID-19 Mitigation Testing Plan (PDF) to their local licensing district office no later than December 7, 2020. For routine weekly screening testing of asymptomatic HCP, GACHs may use laboratories that are able to perform pooled testing. CDPH recommends GACHs begin weekly screening testing of all HCP by December 14, 2020.
HCP with signs or symptoms consistent with COVID-19 should be tested immediately. GACHs should not delay testing of symptomatic HCP until scheduled screening testing. HCP who had a positive viral test in the past three months and are now asymptomatic do not need to be retested as part of facility-wide testing; testing should be considered again (e.g., in response to an exposure) if it is more than three months after the date of onset of the prior infection, or if new symptoms occur. For HCP who develop new symptoms consistent with COVID-19 during the three months after the date of initial symptom onset, if an alternative etiology cannot be identified, then retesting can be considered in consultation with infectious disease or infection control experts.
Testing for Newly Admitted, Newly Symptomatic and Exposed Patients
GACHs should test all patients prior to admission and monitor all patients for the development of COVID-19 symptoms. GACHs should promptly test any newly symptomatic patients and patients who are exposed to a suspected or confirmed case during their hospital stay.
Arrangements with Laboratories to Process Tests
The test used should be an authorized SARS-CoV-2 virus nucleic acid tests for symptomatic or asymptomatic patients or antigen detection assay which should be used only for symptomatic individuals (unless limited nucleic acid testing capacity is available, in which case screening testing using antigen tests in asymptomatic individuals should be repeated every three days) as recommended for testing by CDC, with results obtained rapidly (e.g., within 48 hours). Detailed information regarding SARS-CoV-2 testing can be found on the California COVID-19 Testing Taskforce website found under “labs with testing capacity”. Resources include, but are not limited to, types of tests available, lab resources for testing, and testing prioritization guidance.
Plans for Use and Follow-up of Test Results
CDPH recommends that GACHs that implement HCP testing programs include policies and procedures addressing the use of test results, including:
- How results will be explained to HCP
- How to communicate information about any positive cases of HCP in the facility to responsible parties
- How results (positive or negative) will be tracked for HCP at the facility and methods for reporting results to CDPH and the LHD (facilities may refer to AFL 20-75 Coronavirus Disease 2019 (COVID-19) Outbreak Investigation and Reporting Thresholds for additional guidance on reporting testing results)
- How results will be used to guide implementation of infection control measures, including plans for notification and testing of other HCP and patients exposed to positive HCP
- A procedure for addressing HCP that decline or are unable to be tested
- Plans to address potential staffing shortages for positive HCP who are excluded from work
Procedures for the Duration of Work Exclusion of HCP Who Test Positive
- In general, HCP with COVID-19 should be excluded from work for the duration of their isolation period.
- GACHs should follow CDC Guidance on Mitigating Staffing Shortages, and CDC Return to Work guidance to determine when HCP may return to work.
GACHs may submit any questions about this AFL or about infection prevention and control of COVID-19 to the CDPH Healthcare-Associated Infections Program via email at HAIProgram@cdph.ca.gov or email@example.com.
If you have any questions about state testing prioritization plans, please contact the Testing Taskforce at firstname.lastname@example.org.
Original Signed by Heidi W. Steinecker
Heidi W. Steinecker
- Blueprint for a Safer Economy
- CDC Interim Guidance on Testing Healthcare Personnel for SARS-CoV-2
- California COVID-19 Testing Taskforce
- Testing for COVID-19: PCR, Antigen, and Serology (PDF)
- Lab Resources for Testing
- CDPH Updated COVID-19 Testing Guidance
- CDC Interim U.S. Guidance for Risk Assessment and Work Restrictions for Healthcare Personnel with Potential Exposure to COVID-19
- AFL 20-75 Coronavirus Disease 2019 (COVID-19) Outbreak Investigation and Reporting Thresholds
- CDC Guidance on Mitigating Staffing Shortages
- CDC Criteria for Return to Work for Healthcare Personnel with SARS-CoV-2 Infection (Interim Guidance)
- CDPH Guidance on the Use of Antigen Tests for Diagnosis of Acute COVID-19
- Department of Managed Healthcare (DMHC) Frequently Asked Questions (FAQs)
- Title 8 of California Code of Regulations (CCR) section 5199(a)(4)
- General Acute Care Hospital COVID-19 Mitigation Testing Plan (PDF)
 Healthcare Personnel (HCP): HCP refers to all paid and unpaid persons serving in healthcare settings who have the potential for direct or indirect exposure to patients or infectious materials, including body substances (e.g., blood, tissue, and specific body fluids); contaminated medical supplies, devices, and equipment; contaminated environmental surfaces; or contaminated air. HCP include, but are not limited to, emergency medical service personnel, nurses, nursing assistants, physicians, technicians, therapists, phlebotomists, pharmacists, students and trainees, contractual staff not employed by the healthcare facility, and persons not directly involved in patient care, but who could be exposed to infectious agents that can be transmitted in the healthcare setting (e.g., clerical, dietary, environmental services, laundry, security, engineering and facilities management, administrative, billing, and volunteer personnel).