With monkeypox infections on the rise in the United States and Arizona, it’s important to communicate NOAH’s established guidelines for employees who suspect they may be infected.
General Guidelines For All Employees
Please see our NOAH blog article Monkeypox: What you need to know for symptoms and other information about the spread of monkeypox.
If an Employee Suspects they have Monkeypox:
- Self-isolate at home
- Notify your direct leader
- Notify Employee Health – Eva Cole ecole@honorhealth.com. Employee Health will consult with the Medical Chief (Dr. Jennifer Vanyo-Novak) as needed to determine next steps (ex. need to continue self-isolation, need to seek testing with PCP or at FastMed).
Employee is cleared for return to work when:
- notified of negative monkeypox result, or
- recovered from symptoms of confirmed monkeypox illness and all skin lesions have scabbed over and a new layer of skin has formed
If an Employee is Exposed to a Patient with Monkeypox:
- Patient seen in clinic with presumed monkeypox confirmed to have monkeypox infection
- Provider is to notify Employee Health (Eva Cole) of the positive result via TEAMs and route the chart to Eva in Epic.
- The Provider should also notify their Practice Manager (or delegate) and work together to identify employees potentially exposed. The Practice Manager (or delegate) will forward this list to Employee Health (Eva Cole) to reach out to impacted staff members.
- Employee Health will email potentially exposed employees with symptoms to watch for and report
- Early symptoms: fever, malaise, headache, sore throat, cough, and lymphadenopathy
- Followed by a rash
For your reference email wording will be as follows:
- Employees with unprotected exposures (not wearing a *surgical mask at minimum)
- It has come to our attention that you may have had unprotected exposure (without recommended PPE) to a patient who tested positive for monkeypox (on ___ date). It is important to monitor yourself for symptoms, especially within the 21 days following your exposure. Early symptoms of monkeypox include fever, malaise, headache, sore throat, cough, and lymphadenopathy (swollen lymph nodes). These early symptoms are followed by a rash. You can continue to work but you will need to check your temperature twice daily. You will also need to discuss any evidence of fever, rash, or other symptoms with your supervisor each morning when you get to work until (___ date, 21 days post-exposure). Any other symptoms of monkeypox should also be reported to your supervisor. If you have any questions, please don’t hesitate to reach out by phone, email, or Teams message.
*The required PPE for interaction with a possible monkeypox case includes surgical mask, eye protection, gown, and gloves. Medical Providers should wear N95 masks during patient encounters due to their prolonged exposure to the patient and overlap of symptoms with possible COVID-19 illness. Glasses used for vision correction do not count as eye protection.
- Exposures for employees adhering to recommended PPE
- It has come to our attention that you may have been exposed to a patient who tested positive for monkeypox (on ___ date). It is important to monitor yourself for symptoms, especially within the 21 days following your exposure. Early symptoms of monkeypox include fever, malaise, headache, sore throat, cough, and lymphadenopathy (swollen lymph nodes). These early symptoms are followed by a rash. If you experience any of these symptoms, please notify your supervisor immediately. If you have any questions, please don’t hesitate to reach out by phone, email, or Teams message.
Monitoring Exposed Healthcare Professionals
Any healthcare worker who has cared for a monkeypox patient should be alert to the development of symptoms that could suggest monkeypox infection, especially within the 21 day period after the last date of care.
Healthcare workers who have unprotected exposures (i.e., not wearing at minimum a surgical mask) to patients with monkeypox do not need to be excluded from work duty, but should undergo active surveillance for symptoms, which includes measurement of temperature at least twice daily for 21 days following the exposure. Prior to reporting for work each day, the healthcare worker should be interviewed regarding evidence of fever or rash.
Healthcare workers who have cared for or otherwise been in direct or indirect contact with monkeypox patients while adhering to recommended infection control precautions may undergo self-monitoring or active monitoring as determined by the health department.
A healthcare worker who has cared for a patient with confirmed monkeypox and subsequently develops symptoms concerning for monkeypox should immediately notify their Practice Manager (or delegate), Employee Health, and seek testing through their PCP and FastMed. Employee Health will do outreach to possible exposures (will send out email as above) and initiate tracking as appropriate (check-ins on day 1 of notification and then day 7, day 14, and day 21 after exposure).
Additional Information
Keeping our lobbies safe and clean:
- At a minimum the lobbies should be cleaned three times per day (morning, noon, and afternoon). The Front Office Supervisor will determine who is responsible for this task as it may vary clinic to clinic.
- We can supply cleaning wipes in the lobby for patients who would like to do additional wipe downs of their seat (Eva to confirm the type of wipes appropriate for this use).
Important Contact Information
Employee Health: Eva Cole ecole@honorhealth.com
Maricopa County Health Department: (602)506-3747.
CDC guidance for Healthcare Professionals (includes post-exposure monitoring and risk assessment information)
Exposure Risk Assessment and Public Health Recommendations
for Individuals Exposed to a Patient with Monkeypox
Content source: Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Division of High-Consequence Pathogens and Pathology (DHCPP)
Transmission of monkeypox requires prolonged close contact with a symptomatic individual. Brief interactions and those conducted using appropriate PPE in accordance with Standard Precautions are not high risk and generally do not warrant PEP.
Recommendations
- Monitoring§
- PEP¶ – Recommended
Exposure Characteristics
- Unprotected contact between a person’s skin or mucous membranes and the skin, lesions, or bodily fluids from a patient (e.g., any sexual contact, inadvertent splashes of patient saliva to the eyes or oral cavity of a person, ungloved contact with patient), or contaminated materials (e.g., linens, clothing) -OR-
- Being inside the patient’s room or within 6 feet of a patient during any procedures that may create aerosols from oral secretions, skin lesions, or resuspension of dried exudates (e.g., shaking of soiled linens), without wearing an N95 or equivalent respirator (or higher) and eye protection -OR-
- Exposure that, at the discretion of public health authorities, was recategorized to this risk level (i.e., exposure that ordinarily would be considered a lower risk exposure, raised to this risk level because of unique circumstances)
Recommendations
- Monitoring§
- PEP¶ – Informed clinical decision making recommended on an individual basis to determine whether benefits of PEP outweigh risks ¶¶
Exposure Characteristics
- Being within 6 feet for 3 hours or more of an unmasked patient without wearing, at a minimum, a surgical mask -OR-
- Activities resulting in contact between sleeves and other parts of an individual’s clothing and the patient’s skin lesions or bodily fluids, or their soiled linens or dressings (e.g., turning, bathing, or assisting with transfer) while wearing gloves but not wearing a gown -OR-
- Exposure that, at the discretion of public health authorities, was recategorized to this risk level because of unique circumstances (e.g., if the potential for an aerosol exposure is uncertain, public health authorities may choose to decrease risk level from high to intermediate)
Recommendations
- Monitoring§
- PEP¶ – None
Exposure Characteristics
- Entered the patient room without wearing eye protection on one or more occasions, regardless of duration of exposure -OR-
- During all entries in the patient care area or room (except for during any procedures listed above in the high-risk category), wore gown, gloves, eye protection, and at minimum, a surgical mask -OR-
- Being within 6 feet of an unmasked patient for less than 3 hours without wearing at minimum, a surgical mask -OR-
- Exposure that, at the discretion of public health authorities, was recategorized to this risk level based on unique circumstances (e.g., uncertainty about whether Monkeypox virus was present on a surface and/or whether a person touched that surface)
Recommendations
- Monitoring§ – None
- PEP¶ – None
Exposure Characteristics
- Exposure that public health authorities deemed did not meet criteria for other risk categories
Abbreviations: PEP = postexposure prophylaxis.
† Period of interest was from onset of prodromal symptoms through resolution of the rash (i.e., shedding of crusts and observation of healthy pink tissue at all former lesion sites).
§ Monitoring includes ascertainment of selected signs and symptoms of monkeypox: fever (≥100.4°F [≥38°C]), chills, new lymphadenopathy (periauricular, axillary, cervical, inguinal), and new skin rash through 21 days after the exposure to the patient or the patient’s materials. Monitoring could involve in-person visits, regular communications (e.g., phone call or another system) between public health representatives and the person under monitoring, self-monitoring by persons and reporting of symptoms to health departments only if symptoms appear, or another reliable system determined by the health department. Health departments should take into consideration the person’s exposure risk level, the number of persons needing monitoring, time since exposure, and available resources, when determining the type of monitoring to be conducted. Persons should be advised to self-isolate if any symptoms develop. Persons who report only chills or lymphadenopathy should remain at their residence, self-isolate for 24 hours, and monitor their temperature for fever; if fever or rash do not develop and chills or lymphadenopathy persist, the person should be evaluated by a clinician for the potential cause. Clinicians can consult with the state health department if monkeypox is suspected. If a fever or rash develops, CDC should immediately be consulted.
¶ ACAM2000 and Jynneos are available for PEP.
¶¶ PEP can be considered for contact through activities such as assistance with bathing, dressing, transferring, or other activities.
