This week, multiple states across the nation announced increased funding to be used to help provide COVID-19 testing and contact tracing. Contact tracing involves retracing movements of an individual with COVID-19 to locate, test, and isolate anyone who has come in close contact with that individual, which includes anyone who was within 6 feet of the infected individual for at least 15 minutes starting from 48 hours before illness onset until the time the infected individual was isolated. Contact tracing is used in nursing facilities to identify and quarantine staff, residents, and visitors with potential exposure to COVID-19. In the Health Departments: Interim guidance on developing a COVID-19 case investigation and contact tracing plan, the Centers for Disease Control (CDC) states that COVID-19 investigations and contract tracing in nursing facilities should be planned jointly as a collaboration between the facility and the health department, with initial discussions focused on data sharing and division of responsibilities.
Before widespread transmission of the virus occurred, CDC recommended an aggressive approach to identifying exposed staff and residents. As community spread of COVID-19 occurred in many areas, this approach became impractical and the CDC recommended that facilities consider forgoing formal contact tracing and work restrictions for exposed staff in favor of universally applied screening and source control. On May 19, the CDC issued updated guidance that describes a process for resuming contact tracing and the application of work restrictions that can be considered in areas where community spread is declining and when the capacity exists to perform these activities without compromising other critical infection prevention and control functions. Using this guidance, when there is a case of COVID-19 in a resident or staff member, the facility will use contact tracing to identify individuals who had prolonged close contact (within 6 feet of the individual for 15 minutes or more) with the individual in the 48 hours before symptom onset and evaluate what personal protective equipment was used during the contact to determine if the staff member must be excluded from work.
Due to the number of people potentially involved, contact investigation of patients with COVID-19 potentially exposed in health care facilities is complex. In addition to interactions among staff members, it is important to assess interactions between residents and staff, including non-direct care staff such as activity coordinators, food service staff, and environmental services, and resident to resident interactions in all areas of the facility occurring in the 48 hours prior to the onset of illness until the time the resident or staff was isolated. For each person exposed, the interaction between the infected individual and the exposed contacts will need to be investigated to determine the nature of the interaction, the duration of the contact and the PPE used during the contact so that appropriate actions to prevent transmission can be taken based on the level of risk identified.
Facilities with quick contact tracing following infections will be better positioned to prevent further outbreaks. It is important to ensure you have processes in place for quickly identifying close contacts and to maintain documentation of your contact tracing efforts when new cases of COVID-19 occur in your facility. Technology is emerging as a way to assist in the contact tracing process through wearable devices, such as wristbands or Bluetooth-enabled badges, and smartphone apps that offer contact tracing, location tracking, and room traffic tools to retrace the path of an infected individual to determine who they had contact with and the duration of the exposure.