November 12, 2020

CDC: Report Identifies COVID-19 Risks to Healthcare Personnel and Residents in Long-Term Care Settings

Healthcare personnel who work in long-term care and congregate living facilities face special risks related to COVID-19, according to a report on healthcare worker infections in Minnesota published by CDC on Oct. 30. The report disclosed that healthcare workers in skilled nursing, assisted living, group home, and related settings worked more often while symptomatic for COVID-19 and were more likely to test positive for SARS-CoV-2, compared to healthcare workers in acute care settings. The report also found that healthcare workers in long-term care settings were less likely to wear appropriate personal protective equipment and could also pose a transmission risk to both coworkers and facility residents.

Between March 6—the date of Minnesota’s first confirmed case of COVID-19—and July 11, the Minnesota Department of Health (MDH) and partner healthcare facilities identified 21,406 exposures to SARS-CoV-2 among healthcare workers. Of these, 25 percent were classified as higher-risk exposures, occurring when workers had close, prolonged contact with a person known to have COVID-19, their secretions, or their excretions, while not wearing recommended PPE, or while outside of healthcare settings in the household or community.

MDH staff conducted 20-minute phone interviews with healthcare workers who had higher-risk exposures, which included questions about the circumstances of exposure, including PPE use. MDH recommended that these workers undergo voluntary quarantine, including exclusion from work; complete a daily symptom survey for 14 days after the last exposure; and undergo SARS-CoV-2 testing if symptoms appeared.

Of the higher-risk exposures that occurred in healthcare settings, 32 percent involved acute or ambulatory care patients and 27 percent involved long-term care or congregate living facility residents. An additional 23 percent involved multiple workers or residents in long-term care or congregate living facilities with four or more simultaneous cases. The remaining 18 percent of higher-risk exposures involved a coworker.

These findings indicate the heightened potential for SARS-CoV-2 transmission in such facilities. In fact, a single COVID-19 case in these facilities was found to result in a median of three higher-risk exposures to workers, compared to a median of one exposure in acute care.

Of healthcare workers with higher-risk exposures who completed the MDH-requested daily surveys, those working in group homes tested positive for COVID-19 at the highest rate (16 percent). Workers in group living and long-term care facilities returned to work after high-risk exposures, worked while symptomatic, and tested positive for SARS-CoV-2 during the monitoring program more often than their counterparts in acute care. In addition, significantly fewer workers at residential facilities, compared to acute care professionals, reported wearing PPE at the time of their exposure.

In addition to the high risk of SARS-CoV-2 infection posed to healthcare workers in residential facilities, the report also found that one-third of higher-risk exposures occurred through social or household contacts, not through patient care. While most healthcare workers recognize potential exposure risks to their patients or residents, the report suggested they may neglect social distancing or PPE in interactions with their coworkers. The report advised that interventions would be necessary to address both the exposure risk to healthcare workers in congregate living and long-term care facilities, and the potential that workers may inadvertently expose their coworkers.