Pan American Health Organization · Interim recommendations, 13 April 2020
Interim recommendations for assessing occupational exposure risk and managing health workers exposed to COVID-19 in healthcare settings.
- Issuer
- Pan American Health Organization
- Edition
- Interim recommendations, 13 April 2020
- Audience
- Health facility managers, occupational health services, healthcare workers
- Evidence
- Expert consensus based on early pandemic evidence
- Reviewed
- 20 Oct 2026 · GMJ
What this guideline says
GMJ summary
This interim guidance from the Pan American Health Organization provides a risk-stratified approach to managing health workers exposed to COVID-19 in healthcare facilities. It classifies exposures as either low-risk (providing care with proper personal protective equipment) or high-risk (close contact without proper PPE or during aerosol-generating procedures without airborne precautions), and prescribes different management pathways accordingly.
The core management strategy distinguishes between asymptomatic health workers with low-risk exposure, who continue working with self-monitoring, and those with high-risk exposure, who must stop working for 14 days from last exposure with active monitoring and home quarantine. Symptomatic health workers must remain off work until symptom remission and two negative PCR tests 24 hours apart, or 7 days after symptom remission if PCR is unavailable. The guidance emphasizes rational PPE use, hand hygiene following WHO’s 5 Moments, and prioritizes seasonal influenza vaccination for all health workers to maintain healthcare capacity.
The document provides practical tools including a management flowchart, detailed definitions of exposure risk levels, and a self-monitoring form for tracking symptoms over the 14-day incubation period. It notes the particular vulnerability of health workers, citing Chinese data showing 29% of hospitalized COVID-19 patients in one Wuhan series were healthcare professionals, with more than 3,300 infected in early epidemic phases.
Key points
For clinicians — doses and thresholds as stated in the guideline
- Low-risk exposure (providing care with proper PPE): asymptomatic health workers continue working with self-monitoring for respiratory symptoms and fever
- High-risk exposure (close contact without proper PPE or AGPs without airborne precautions): asymptomatic health workers stop working for 14 days from last exposure with active monitoring and home quarantine
- Symptomatic health workers with any exposure: stop working until symptom remission and two negative PCR tests 24 hours apart, or 7 days after symptom remission if PCR unavailable
- Standard + contact + droplet precautions for all suspected or confirmed COVID-19 cases; add airborne precautions during aerosol-generating procedures
- Aerosol-generating procedures include: positive pressure ventilation (BiPAP, CPAP), endotracheal intubation, airway suction, high-frequency oscillatory ventilation, tracheostomy, thoracic physiotherapy, nebulizer treatment, sputum induction, bronchoscopy, and autopsy
- Restrict contact between recovered health workers and immunocompromised patients until 14 days following symptom remission
- Health workers are priority group for seasonal influenza vaccination to maintain healthcare operations and reduce transmission to vulnerable patients
- Pregnant women, people over 60 years, immunosuppressed individuals, and those with decompensated chronic diseases require individual physician evaluation even with low-risk exposure
Actions to take when a health worker has been exposed to COVID-19 in health facilities
Table extracted from the guideline
| Health status | Exposure risk | Sick leave from work | Surveillance / Monitoring of signs and symptoms |
|---|---|---|---|
| Asymptomatic | Low-risk exposure in health facilities | Not indicated | Self-monitoring; seek medical care if signs and symptoms appear |
| Asymptomatic | High-risk exposure to COVID-19 patient in health service | Stop working for 14 days from last exposure | Active monitoring; screen if signs and symptoms appear; home quarantine |
| Asymptomatic | Contact of confirmed COVID-19 at home | Stop working for 14 days from last exposure | Active monitoring; screen if signs and symptoms appear; home quarantine |
| Symptomatic | Low- or high-risk exposure in health facilities or at home | Stop working until remission of symptoms and two negative PCRs 24 hours apart; if PCR not available, 7 days after symptom remission | Clinical case management according to local protocols |
Source: Pan American Health Organization, Care for health workers exposed to the new coronavirus (COVID-19) in health facilities. Reproduced in summary form.
From the guideline
Verbatim
“In a description of 138 patients infected by COVID-19 treated in Wuhan (China), 40 patients (29%) were identified as health professionals, which suggests how vulnerable these workers are.”
Editor’s perspective
Why this matters for Georgia and the region
Prof. Giorgi Pkhakadze, MD, MPH, PhD
Editor-in-Chief, Georgian Medical Journal · Chair, Public Health Institute of Georgia · WHO consultant, health and migration
As we reflect on the COVID-19 pandemic's impact on healthcare systems across Georgia and the wider Caucasus region, this PAHO guidance provides a crucial framework that remains applicable to ongoing occupational health protection. The risk-stratified approach—differentiating between low-risk exposures that permit continued work with self-monitoring and high-risk exposures requiring 14-day quarantine—offers a rational balance between health worker safety and maintaining healthcare capacity, a challenge Georgian facilities faced acutely during pandemic surges. I would particularly emphasize to Georgian colleagues the distinction between aerosol-generating procedures requiring N95/FFP2 respirators and routine care requiring surgical masks, as this differentiation is essential for rational PPE use in resource-constrained settings. The practical implementation caveat for Georgia is ensuring that occupational health services have the capacity for active monitoring of quarantined staff and that clear reporting pathways exist, which may require strengthening occupational health infrastructure in smaller regional facilities that were already understaffed before the pandemic placed additional burdens on the health workforce.
ORCID 0000-0001-7609-4515 · Perspective written for the GMJ Guidelines Library, 20 Oct 2026
Applicability
Georgia and the South Caucasus
For Georgia and the South Caucasus, this guidance remains relevant for managing occupational COVID-19 exposure in healthcare settings, particularly as the region continues to experience periodic waves of infection. National occupational health programmes should ensure clear protocols exist for exposure risk assessment, especially distinguishing between aerosol-generating procedures requiring airborne precautions and routine care requiring droplet precautions. Georgia’s healthcare facilities would need to maintain adequate stocks of appropriate PPE (surgical masks for droplet precautions, N95/FFP2 respirators for aerosol-generating procedures), establish clear reporting pathways to occupational health services, and ensure seasonal influenza vaccination coverage among health workers to maintain healthcare capacity. The 14-day quarantine period for high-risk exposures and criteria for return to work (two negative PCR tests 24 hours apart or 7 days post-symptom resolution) should be integrated into national infection prevention and control policies.
Questions this guideline answers
Quick answers
What is the difference between low-risk and high-risk occupational exposure to COVID-19?
Low-risk exposure means providing direct care to a COVID-19 patient following recommendations for proper PPE use. High-risk exposure includes close contact with a COVID-19 case, providing direct care or performing aerosol-generating procedures without proper PPE, or contact with bodily fluids or contaminated environments without proper PPE or hand hygiene.
Can asymptomatic health workers with low-risk exposure continue working?
Yes, asymptomatic health workers with low-risk exposure do not need sick leave. They should continue self-monitoring for respiratory symptoms and fever, and seek medical care and report to their supervisor if symptoms appear.
How long must health workers quarantine after high-risk exposure?
Health workers with high-risk exposure must stop working for 14 days from the last exposure, undergo active monitoring for symptoms, and remain in home quarantine even if they remain asymptomatic throughout this period.
When can symptomatic health workers return to work?
Symptomatic health workers can return to work after symptom remission and two negative PCR tests taken 24 hours apart. If PCR testing is unavailable, they may return 7 days after symptom remission. However, contact with immunocompromised patients should be restricted until 14 days following symptom remission.
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Quality & accreditation
- ASF Hospital — Standard 5 — Safety & Emergency Preparedness
- ASF Medical Transport — Standard 5 — Infection Prevention & Control
- ASF Laboratory — Standard 7 — Examination: Process & Safety
- ASF Hospital — Standard 11 — Critical Care
- ASF Medical Transport — Standard 6 — Emergency Response During Transport
Other guidelines on this topic
- Considerations for the Implementation and Management of Contact Tracing for Coronavirus Disease 2019 (COVID-19) in the Region of the Americas
- Reliance for Emergency Use Authorization of Medicines and Other Health Technologies in a Pandemic (e.g. COVID-19)
- Ethics guidance for the use of scarce resources in the delivery of critical health care during the COVID-19 pandemic
- An Overview of Current Social Distancing Measures and Required Evidence for Determining Optimal Time for Relaxing Such Measures
- Enhancing COVID-19 Mortality Surveillance in Latin America and the Caribbean through All-Cause Mortality Surveillance
- Issuer
- Pan American Health Organization
- Type
- Procedures, manuals, guidelines
- Edition
- Interim recommendations, 13 April 2020
- Status
- Current
- Published
- 2020-01-01
- Scope
- Management of occupational exposure to COVID-19 in healthcare settings
- Audience
- Health facility managers, occupational health services, healthcare workers
- Licence
- CC BY-NC-SA 3.0 IGO
- Evidence
- Expert consensus based on early pandemic evidence
- Record history
- Created 20 Oct 2026 · updated 20 Oct 2026 · next check Apr 2027
Pan American Health Organization. Care for health workers exposed to the new coronavirus (COVID-19) in health facilities. Interim Recommendations, 13 April 2020. Washington, D.C.: PAHO; 2020. (PAHO/PHE/IM/Covid-19/20-005).GMJ Guidelines Library records are original summaries written by the GMJ editorial team from the issuer’s published document and reviewed by a physician. They do not replace the full guideline. The document is the copyright of its issuer and is linked, not hosted. Spotted an error or a newer edition? Tell the Guidelines Desk.
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