Interim Guidance for Public Health Personnel Evaluating Persons Under Investigation (PUIs) and Asymptomatic Close Contacts of Confirmed Cases at Their Home or Non-Home Residential Settings

As part of the risk assessment and public health management of persons with potential COVID-19, public health personnel will typically conduct interviews and assess these individuals for fever or other symptoms of COVID-19. In certain circumstances they will also obtain respiratory specimens. This guidance is intended to address recommended infection prevention and control practices when these activities are performed at a home or non-home residential settings, which warrant additional considerations beyond those described for healthcare settings.

For recommendations on the evaluation of PUIs in healthcare settings refer to the Interim Infection Prevention and Control Recommendations for Patients with Confirmed Coronavirus Disease 2019 (COVID-19) or Persons Under Investigation for COVID-19 in Healthcare Settings.

Interviewing and assessing persons with symptoms (PUIs for COVID-19):

• Make every effort to interview the PUI by telephone, text monitoring system, or video conference.
  • Temperature monitoring could be reported by phone or shown to a provider via video conferencing.
• If public health personnel must interview a PUI in their home, the public health personnel should wear recommended personal protective equipment (PPE), including a gown, gloves, eye protection (e.g., goggles, a disposable face shield that covers the front and sides of the face), and respiratory protection that is at least as protective as a NIOSH-approved N95 filtering facepiece respirator, as recommended in the Interim Infection Prevention and Control Recommendations for Patients with Confirmed Coronavirus Disease 2019 (COVID-19) or Persons Under Investigation for COVID-19 in Healthcare Settings.
  • Hand hygiene should be performed before putting on and after removing PPE using alcohol-based hand sanitizer that contains 60 to 95% alcohol.
  • PPE should ideally be put on outside of the home prior to entry into the home.
    • If unable to put on all PPE outside of the home, it is still preferred that face protection (i.e., respirator and eye protection) be put on before entering the home. Alert persons within the home that the public health personnel will be entering the home and ask them to move to a different room, if possible, or keep a 6-foot distance in the same room. Once the entry area is clear, enter the home and put on a gown and gloves.
  • Ask PUI if an external trash can is present at the home, or if one can be left outside for the disposal of PPE.
  • PPE should ideally be removed outside of the home and discarded by placing in external trash can before departing location. PPE should not be taken from the PUI’s home in public health personnel’s vehicle.
    • If unable to remove all PPE outside of the home, it is still preferred that face protection (i.e., respirator and eye protection) be removed after exiting the home. If gown and gloves must be removed in the home, ask persons within the home to move to a different room, if possible, or keep a 6-foot distance in the same room. Once the entry area is clear, remove gown and gloves and exit the home. Once outside the home, perform hand hygiene with alcohol-based hand sanitizer that contains 60 to 95% alcohol, remove face protection and discard PPE by placing in external trash can before departing location. Perform hand hygiene again.

Interviewing and assessing persons without symptoms (asymptomatic close contacts who have been exposed to a lab-confirmed case of COVID-19):

• Make every effort to interview the asymptomatic close contact by telephone, text monitoring system, or video conference.
  • Temperature monitoring could be reported by phone or shown to a provider via video conferencing.
• If public health personnel must interview the asymptomatic close contact in person, the public health personnel should stay at least 6 feet away from the asymptomatic close contact and ask them if they have had fevers or respiratory symptoms. If the interview and assessment is occurring in the home environment, the public health personnel should not enter the home until these questions have been asked and the asymptomatic close contact has been determined to be afebrile by temperature measurement.
  • If the asymptomatic close contact reports fever or symptoms, they should be considered a PUI and referred for further medical evaluation as appropriate. Public health personnel should document temperature measurement and description of symptoms.
• If the asymptomatic close contact does not report fever or symptoms, they should be instructed to take their own temperature and report the result. If the asymptomatic close contact denies symptoms and fever is not detected, it remains appropriate to stay at least 6 feet away during further interactions even if entering the home environment. If they are not able to take their own temperature, the public health personnel should:
  • Perform hand hygiene
  • Put on a facemask and eye protection (consider adding gloves if entering the asymptomatic close contact’s home)
  • Proceed with checking the asymptomatic close contact’s temperature
  • Remove and discard PPE
  • Perform hand hygiene using alcohol-based hand sanitizer that contains 60 to 95% alcohol

Diagnostic respiratory specimen collection for all individuals (i.e., PUIs for COVID-19 or asymptomatic) at home:

• Testing for the virus that causes COVID-19 should be conducted outdoors if climate allows. If conducted in the home, specimen collection should be performed in the area of the house where the individual being tested self-isolates.
  • Only the public health personnel and individual being tested should be in the room when testing is performed.
  • Collecting diagnostic respiratory specimens (e.g., nasopharyngeal swab) is likely to induce cough or sneezing.
  • Non-aerosol-generating procedures should be performed before aerosol-generating procedures. Aerosol-generating procedures should be the last activity performed just before leaving the home.
• Public health personnel collecting specimens should wear recommended PPE, including a gown, gloves, eye protection, and respiratory protection that is at least as protective as a NIOSH-approved N95 filtering facepiece respirator, as recommended in the Interim Infection Prevention and Control Recommendations for Patients with Confirmed Coronavirus Disease 2019 (COVID-19) or Persons Under Investigation for COVID-19 in Healthcare Settings.
  • Hand hygiene should be performed before putting on and after removing PPE using alcohol-based hand sanitizer that contains 60 to 95% alcohol.
  • PPE should ideally be put on outside of the home prior to entry into the home
    • If unable to put on all PPE outside of the home, it is still preferred that face protection (i.e., respirator and eye protection) be put on before entering the home. Alert persons within the home that the public health personnel will be entering the home and ask them to move to a different room, if possible, or keep a 6-foot distance in the same room. Once the entry area is clear, enter the home and put on a gown and gloves.
  • Ask person being tested if an external trash can is present at the home, or if one can be left outside for the disposal of PPE.
  • PPE should ideally be removed outside of the home and discarded by placing in external trash can before departing location. PPE should not be taken from the home of the person being tested in public health personnel’s vehicle.
    • If unable to remove all PPE outside of the home, it is still preferred that face protection (i.e., respirator and eye protection) be removed after exiting the home. If gown and gloves must be removed in the home, ask persons within the home to move to a different room, if possible, or keep a 6-foot distance in the same room. Once the entry area is clear, remove gown and gloves and exit the home. Once outside the home, perform hand hygiene with alcohol-based hand sanitizer that contains 60 to 95% alcohol, remove face protection and discard PPE by placing in external trash can before departing location. Perform hand hygiene again.