A Framework for Sustainable Contact Tracing and Exposure Investigation for Large Health Systems

Abstract

Contact tracing is a cornerstone of communicable disease containment and involves identifying, quarantining, and monitoring contacts of infected people. Although contact tracing is a known evidence-based strategy in the community setting, the COVID-19 pandemic highlighted the challenges to implementing labor-intensive contact tracing in the occupational setting of large health care systems and hospitals, the epicenter of the pandemic. We present a framework for feasible, scalable COVID-19 contact tracing in a large multistate health system in the United States employing approximately 69,000 health care personnel. The framework is shared with sufficient details to allow adoption or adaptation by other health systems. Continuous enhancement, optimization, and evaluation of the framework are ongoing.

Figure 1

Framework for scaling occupational health contact tracing during a pandemic.

Figure 2

Exposure risk to health care personnel (HCP) modified based on personal protective equipment (PPE). ^aThe risk category for these rows would be elevated by one level if HCP performed or were present for a procedure likely to generate higher concentrations of respiratory secretions or aerosols. For example, HCP who were wearing a gown, gloves, eye protection and a facemask (instead of a respirator) during an aerosol-generating procedure would be considered to have a medium-risk exposure. ^bHCP not using all recommended PPE who have only brief interactions (< 6ft, <5min) with a patient regardless of whether patient was wearing a facemask are considered low-risk. ^cHCP who walk by a patient or who have no direct contact with the patient or their secretions/excretions and no entry into the patient room are considered to have no identifiable risk. ^dHCP NOT wearing a facemask or respirator in the role of desk triage, intake staff, reception, scheduling are considered to have LOW risk exposure due to very brief exposure while the patient was wearing a mask. ^eEye protection must be a face shield, safety goggles, or safety glasses.

Figure 3

Exposed employee assessment algorithm. HCP = health care personnel; OHS = Occupational Health Services.

Figure 4

Exposure investigation process overview.

Figure 5

Health care personnel with COVID-19 assessment form.

Figure 6

Staff Exposure Contact Log.

Figure 7

Exposed Employee Assessment Form.

Figure 7

Exposed Employee Assessment Form.