The Problem of the Asymptomatic Health Care Worker (HCW)

Our community is experiencing a surge of COVID in our Senior Living Facilities with the vast majority of cases traced to asymptomatic HCWs, particularly those working in multiple facilities.  This problem is further compounded by delays in reporting the results of mandated HCW COVID testing as long as 10 days.  Our contact tracing suggests that much of the initial infection of HCWs is occurring in the home setting where there is intergenerational living and multiple relatives living in close proximity.  We have traditional sterile hygiene measures expected of HCWs going from one facility to another, but know that transmission risk during intimate care may occur through medical masks, which may be only 45-70% effective in containing the virus, versus 95+% with certified N95 masks that have been fit tested.  

Recently, the CDC did give guidance that optimal HCW transmission risk reduction in the SNF setting requires use of fit tested N95 masks and face shields with shields that extend behind the ears.  As these become available, this should be our standard.

In the interim, what are our other options for reducing this vector of COVID in our facilities?  On a recent SNF workgroup call with our local health department (LHD) staff, a mandate that HCWs only work at one facility was mentioned, but rejected, since this would likely result in most facilities being much more understaffed, and would be a hardship on our essential workers, who support their families by working at multiple facilities.   Other things to consider include:

  1. Adding a requirement that HCWs working at multiple facilities use medical masks and face shields, until N95’s become available, while working at all of their facilities.
  2. The results of COVID tests for all HCWs should become available ideally within 24 hr., but especially for those working in multiple facilities.  Yesterday, a SNF reported success finding a lab in Orange County provided results to their facility by FedEx within 24 hrs.  This type of community effort to identify highly functional labs is crucial for minimizing HCW virus transmission.
  3. Facilities must report to their LHD all workers who work at multiple facilities to ensure they are trained in heightened IP/C measures and trained to reduce the risk of out-of-facility COVID exposure and effective home quarantine if a person becomes positive.
  4. HCWs need to know that they will be fully supported financially by all their facilities during the 2-week quarantine.
  5. HCWs must report a positive test within 12 hours of receiving the report, to the administrator on duty for their primary work facility.  In that report, they must identify all of the facilities where they had worked over the preceding 14 days.
  6. The administrator on duty must contact all of these facilities within 12 hours of the positive test being identified, so each facility can notify the LHD and institute their response protocol.  

On a recent call, I suggested we tie all communication with our workers and the public to the message, “COVID Prevention Matters.” To date, I’ve seen our country focus on expensive downstream care by spending $3 billion for ventilators and focus of acute hospitals on securing adequate PPE and increasing ICU beds, ventilators, and negative pressure rooms for COVID surges.  While this traditional approach to past crises may have been effective in the past, the funding and support for preventative care has badly lagged that compromises our ability to keep COVID out of our facilities. We urgently need sufficient PPE recommended by the CDC and testing turn-around time of < 48 hours. This is how we will protect our vulnerable seniors and reduce the need for acute hospital management of COVID. 

We can and must do better.  Remember, “COVID Prevention Matters”!

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Comments on "The Problem of the Asymptomatic Health Care Worker (HCW)"

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Betty Thomas - Wednesday, July 15, 2020

I removed my 98 year old aunt from a skilled facility on April 30 and she is at my home. She is alert and cogitative good. Just a little problem with her short term memory. She can transfer by herself but is non ambulatory. Since in my home and using the bedside commode she is continent.The three years she had been in long term care, she had family visits 2 times a week with an outing. I have had 50 years experience with long term care. Personal and professional. A father and a sister who had Alzheimer's Disease. I was very concerned about my aunt. No family visits and she was depressed when she came to my home. If she was still in the facility she would have died of isolation and loneliness. Also by the time we would be able to visit she would have some dementia. Being a RN and having expert knowledge of long term care. I knew that the staff were the ones who were exposing the resident to the virus. The more a learned about the virus the more it was expedient to remove my aunt from the facility. I am 78 years old myself and in what I consider good health. I have a team of 3 other younger relatives that assist. You are very right. Focus must on the staff and this situation must addressed. Staffing of LVNs and CNAs, improved salaries, in-services and supervision of CNAs need to be addressed along with the virus. Betty Thomas RN, currently part-time instructor El Monte - Rosemead Adult School in the Vocational Nursing and Nurse Assistant Pre-certification Programs

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