Running Your Dermatology Practice During COVID-19
Step 6: Organize your staff
Follow CDC updates and check with your state and local public health departments on regulations concerning group gatherings. Try to limit the number of staff per room in your practice and consider the following guidance:
Educate staff on social distancing in break rooms or lunch areas so they sit at least six feet apart. Staff should wear PPE for office staff meetings or sit at least 6 feet apart. If all staff are vaccinated, they can eat and converse without masks around each other.
When all staff present are fully vaccinated in settings without direct patient contact (E.g., billing office, break room, call center, staff meeting), they do not need to wear masks and/or physically distance from each other.
Practice physical distancing with patients. Train staff to greet patients with a nod, smile, and/or wave. Do not shake hands or hug.
Tell staff not to come into the practice if they exhibit any flu-like illness, loss of taste or smell, other known COVID-19 symptoms, or if they have been in close contact with a COVID-19 infected individual and have not been vaccinated. Staff should follow the CDC’s Return to Work Criteria.
Screen staff each day prior to seeing patients for the presence of flu-like symptoms (cough, fever, sore throat, runny nose, nausea, diarrhea, or shortness of breath), loss of taste or smell, or close contact with individuals who may be infected with COVID-19 if not vaccinated. Consider non-contact temperature screening (the CDC defines 100.0+degree F as fever). If the screen is positive, consistent with possible COVID-19 infection, or there was close contact with an infected individual by an unvaccinated staff member, the staff member should be sent home and instructed to follow CDC’s Return to Work Criteria.
Summary of CDC’s Return to Work Criteria
Except for rare situations, in symptomatic staff, a test-based strategy is not recommended to determine when staff should return to work.
The CDC defines health care worker close contact as being within about 6 feet of an infected person for a total of 15 minutes or more while not wearing recommended PPE. If staff wear PPE throughout the workday and socially distance at other times, they would not be considered at high risk of exposing their co-workers/patients or of being exposed to COVID-19 by them. If the health care worker is fully vaccinated, (i.e., ≥2 weeks following receipt of the second dose in a 2-dose series, or ≥2 weeks following receipt of one dose of a single-dose vaccine) and is within 6 months following receipt of the last dose in the series and has remained asymptomatic since the current COVID-19 exposure, the health care worker would not need to quarantine.
Staff with mild to moderate symptoms should not go to work and should self-isolate for 10 days from symptom onset and at least 24 hours fever-free without fever-reducing medication with other symptoms improved. Staff who were suspected of having COVID-19 and had it ruled out based on a clinical decision that COVID-19 is not suspected and testing is not indicated should be able to return to work (without other suspected or confirmed diagnoses).
If a physician evaluating a symptomatic staff member for COVID-19 decides that antigen testing is indicated and the test is negative, that would indicate that the staff member likely did not have active COVID-19 infection at the time the sample was collected. A second antigen test may be performed at the discretion of the evaluating physician, particularly when a higher level of clinical suspicion for COVID-19 infection exists. Staff who were suspected of having COVID-19 and had it ruled out with at least one negative test should be able to return to work (without other suspected or confirmed diagnoses).
Staff with severe or critical illness should not go to work and should isolate for 20 days from symptom onset and at least 24 hours fever-free without fever-reducing medication with other symptoms improved.
A non-vaccinated staff member that has been exposed to a COVID-19 infected individual, should either not go to work and self-quarantine for 10 days or have a COVID-19 test done at 5-7 days after exposure and not go to work and self-quarantine until the result is known. If negative, they can return to work 7 days after exposure. If positive self-quarantine for 10 days from the date of exposure or test if exposure date is unknown. If symptoms develop, follow the symptomatic health care worker algorithm above. If the staff member previously had COVID-19 within the past three months and remains without symptoms they do not need to quarantine and should not have a COVID-19 test done. If the staff member if fully vaccinated, follow the guidance above for vaccinated health care workers.
Asymptomatic staff without known exposure who decided to get a COVID-19 test and the test came back as positive should not go to work and should self-quarantine for 10 days. If symptoms develop, follow the symptomatic health care worker algorithm above.
Check with your local and state health department for any additional requirements for management of staff that are suspected of having COVID-19.
The CDC has created guidance regarding how to handle health care personnel who may have been exposed to COVID-19.
If findings suggest the possibility of COVID-19 infection, consider referring staff to their primary care physician or local urgent care center for evaluation.
Follow HIPAA protocols if staff are diagnosed with COVID-19. You may inform patients and staff they have encountered someone who has tested positive for COVID-19, however you cannot identify the staff without their consent.
Be flexible and accommodating with staff whenever possible. Childcare and schooling options may be limited during this time.
Make sure you communicate all new procedures with staff in advance of any changes/updates to your office procedures.
Check with your state’s requirements on employee travel. There are still some state and local governments that require people who have recently traveled to certain high COVID-19 prevalence areas to quarantine for 14 days.
Understand the employment-related legal considerations during the pandemic. OSHA allows employers to mandate COVID-19 vaccination as a condition of employment with limited medical or religious exceptions. Each employer should make the decision whether to make COVID-19 vaccination their employees voluntary or mandatory and communicate the rationale clearly with their employees. Review the following Dermatology World articles:
Employment-related legal considerations during the COVID-19 public health crisis
Employment-related legal considerations during COVID-19, Part II
COVID-19 impact on employed dermatologists: Part 1
COVID-19 impact on employed dermatologists: Part 2
All content solely developed by the American Academy of Dermatology