CDC Updates Infection Prevention and Control Guidance

CDC released updates to its COVID-19 infection prevention and control (IPC) guidance on Friday, September 10. In addition to a small number of specific changes to the guidance, CDC merged several setting-specific guidance documents, such as those for dialysis, dental practices, and EMS into the main IPC guidance for health care settings. Previous versions of these setting-specific documents remain available on the CDC website with notation that they have been archived. Note that the setting-specific guidance for nursing homes and long-term care facilities (LTCFs) remains a separate document. These facilities should continue to follow both the general IPC guidance for health care settings and the setting-specific guidance for nursing homes and LTCFs.  

CDC's three current IPC guidance documents for health care settings include:

• General IPC guidance for health care settings 
• Managing exposure and infections in health care personnel (HCP)
• Nursing home and LTCF-specific IPC guidance (note that the general IPC guidance also applies to nursing homes and LTCFs)

Summary of Key CDC IPC Guidance Updates 

• Source control masking continues to be recommended for everyone in health care settings. However, CDC added a few limited circumstances where fully vaccinated individuals in counties with low to moderate community transmission may choose not to wear source control. This option does not apply to individuals who are symptomatic, who have a close contact exposure, are immunocompromised, or are otherwise recommended to wear source control by public health. 
• Asymptomatic, fully vaccinated patients and LTCF residents no longer need to automatically quarantine following a close contact exposure. These individuals should wear source control and be tested as described in the testing section.   
• CDC clarified a number of issues related to testing of asymptomatic HCP following high-risk exposure and for asymptomatic patients and LTCF residents following close contact exposure, including:

• Testing of these individuals should occur immediately (but not earlier than 2 days following exposure) and then again 5-7 days post-exposure.
• These individuals should be tested following exposure regardless of vaccination status.
• Individuals who are exposed to COVID-19 within 90 days of a previous documented COVID-19 infection, and who remain asymptomatic, do not need to be tested.

• The data source used to determine the frequency of routine testing for unvaccinated staff in nursing homes has changed, and is now aligned with the revised CMS testing memo, QSO-20-38-NH. Facilities should utilize CDC community transmission data available on the COVID Data Tracker web page to determine testing frequency for unvaccinated staff members. This is the same data used to determine whether eye protection should be used as part of universal precautions. Testing frequency by transmission levels is as follows:

• Substantial and high transmission: Twice per week testing.
• Moderate: Once per week testing.
• Low: No testing recommendation. Instead, be ready to test all symptomatic staff and residents and close contact exposures. 

• Going forward, there will be two options to approach nursing home and LTCF outbreak testing:

• Contact tracing approach: Target testing based on contact tracing for cases, which may lead to testing for a selected handful of staff and/or residents. If there are concerns about the ability to contact trace or if transmission is identified after contact tracing testing, a wider approach to testing should be implemented. 
• Wider approach: Test a larger area (unit, floor, or facility-wide) depending on the circumstances of the identified positive case or if contact tracing cannot be done. 

• CDC clarified that assisted living facilities (ALFs) should follow the nursing home and LTCF IPC guidance when health care is being delivered to residents within the ALF. This includes care provided by external staff, such as hospice or home health agencies, as well as ALF staff. 

Facilities should review the above documents for full details on these changes. There were no changes made to the guidance on the use of personal protective equipment (PPE) or symptom screening as part of these updates.

DHS resources and web pages are currently under review and will be updated to reflect these changes as needed.