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Federal Register / Vol. 86, No. 116 / Monday, June 21, 2021 / Rules and Regulations
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temporary staff members, resident caregivers, and staff members who might work at multiple facilities. The study authors reported that case count data were aggregated weekly, and resident-weeks were calculated as the total number of occupied beds on the day data were reported. Data on number of staff members employed were not collected, and therefore resident weeks was used as a closest best estimate of the at-risk denominator for staff members. The study authors indicated that cases per 1,000 residentweek were calculated for residents and staff members using the number of COVID19 cases reported in a week over the corresponding 1,000 residentweeks. COVID19 cases in staff members increased during June and July 10.9 cases per 1,000 resident-weeks reported in the week of July 26;
declined during August and September 6.3 per 1,000 resident-weeks in the week of September 13; and increased again by late November 21.3 cases per 1,000 resident-weeks in the week of November 22. The study authors noted that COVID19 rates among nursing home staff followed similar trends in nursing home residents and the surrounding communities, thereby indicating a possible association between COVID19 rates in nursing homes and nearby communities.
Terebuh et al., September 20, 2020
investigated COVID19 clusters in 45
congregate living facilities in Ohio, from March 7 to May 15, 2020. Most of the facilities investigated were healthcare worksites. More than half of the clusters occurred at medical facilities 51% at nursing homes, 11% at assisted living facilities, 7% at treatment facilities, and 2% at intermediate care facilities. The remaining clusters occurred at corrections facilities 7%, group homes 20%, and shelters 2%. Of the combined 598 residents and healthcare employees who were either confirmed to have COVID19 or identified as a probable case based on symptoms and close contact with a confirmed case, healthcare employees represented 167
28% of the confirmed and 37 6% of the probable cases of COVID19. None of the healthcare employees died. The study authors were able to identify the index case in 25 of the clusters, and 88% of the index cases were determined to be healthcare employees.
Studies Focusing on Healthcare Support Services Healthcare support services employees, such as personnel that provide food, laundry, or wastehandling services, are at risk of exposure to patients with SARSCoV2

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and contracting COVID19. Employees who provide healthcare support services usually have less direct contact with patients, but they can have close contact with COVID19 patients or contaminated materials when performing tasks such as cleaning patient rooms, removing waste or dirty laundry from patient rooms, delivering food and picking up used food trays and utensils, or repairing equipment in the patients room. In addition, healthcare support employees can have close and prolonged contact with their co-workers while performing their duties.
One study discussed above Sims et al., November 5, 2020, shows an infection rate among healthcare support services employees that is similar to healthcare employees, such as physicians, who have some patient contact. As noted, support personnel such as facilities/security and administrative support employees had seropositivity rates of approximately 7%
to 8%, which were similar to rates in physicians values estimated from Figure 2B. Both healthcare support employees and physicians had seropositivity rates that were higher than the rates among employees working from home.
Hale and Dayot 2020 examined an outbreak of COVID19 among food service employees that occurred in an academic medical center before masking and physical distancing requirements were implemented. After an employee in the food and nutrition department tested positive, 280 asymptomatic staff were tested. The entire food and nutrition department that was actively working was considered exposed because employees shared a common locker room and break area. Therefore, testing was not limited to employees who worked near the index case as part of their duties. Ten staff members in the department including the index case tested positive during the investigation.
At least seven of the cases were thought to result from transmission from the index case.
Outbreaks for support services have not been well documented and may be encapsulated with incidents for the entire hospital. Local newspaper reports have identified potential incidents in laundry facilities that handle linens contaminated with SARSCoV2. In a New Jersey unionized laundry facility, representatives noted that eight employees had been infected with SARSCoV2 and demanded improvements in infectious disease control implementation Davalos, December 21, 2020. In Canada, a Regina hospital laundry plant was connected with an 18-employee outbreak Martin,
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August 10, 2020. The cause of the outbreak was not determined.
Emergency Medical Services EMS
A limited number of studies have examined the impact of COVID19 on employees who provide EMS e.g., EMTs, paramedics, who are considered healthcare personnel under this standard. The studies that address EMS
often address personnel such as EMTs along with other types of emergency responders such as firefighters, who are not considered healthcare personnel under this standard. EMTs and similar occupations, such as paramedics, have close contact with patients who are or could be infected with SARSCoV2
when they provide medical care or transport those patients. The medical care they provide includes intubation and cardiopulmonary resuscitation, which could generate aerosols and put them at particularly high risk when performing those procedures on someone with confirmed or suspected COVID19.
Prezant et al., 2020 reviewed paid medical leave data for EMS providers and firefighters using New York City fire department electronic medical records from October 1, 2017 through May 31, 2020. The study authors found that as of May 31, 2020, 1,792 of 4,408 EMS
providers 40.7% had been on leave for suspected or confirmed COVID19.
When compared with the medical leave data from before the pandemic including months during influenza periods in prior yearsthe authors found that medical leave for EMS
providers was 6.8% above baseline in March 2020 and peaked at 19.3% above baseline in April 2020. The authors determined that COVID19 was responsible for this increase. The medical leave levels for EMS providers were above those for firefighters. Among firefighters, the data showed that 34.5%
had been on leave for suspected or confirmed COVID19 as of May 31, 2020, and there was a peak in medical leave at 13.0% above baseline in April 2020. A total of 66 1.2% firefighters and EMS providers with COVID19
were hospitalized and 4 died. Despite EMS providers having been given the same PPE not further specified as firefighters, EMS providers had higher rates of COVID19. The study authors concluded that higher rates in EMS
providers were attributable to greater exposure to COVID19 patients while administering medical care.
Weiden et al., January 25, 2021
investigated risk factors for SARSCoV
2 infection and severe disease hospitalization or death in New York City first responders EMS and
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