Updated DOH return-to-work guidance for healthcare personnel
This story appears in the November 2025 edition of The Washington Nurse.
Washington state recently updated interim return-to-work guidance for healthcare personnel following acute viral respiratory infections. The goal of the update is to minimize transmission of viral respiratory infections in the hospital, while balancing patient safety and readiness to return to work with staffing challenges.
The guidance, from the Washington State Department of Health (DOH), applies to all paid and unpaid personnel providing healthcare services in hospitals and other settings.
Before interim guidance was finalized, WSNA Director of Nursing Practice Gloria Brigham and WSNA President Justin Gill met with DOH to review and provide feedback on key elements. This collaboration contributed to the focus on employee return-to-work readiness and the development of a Frequently Asked Questions document designed to provide additional details about return-to-work.
Core DOH Return-to-Work guidance
According to DOH, healthcare personnel with suspected or confirmed viral respiratory infection should be restricted from work until the following criteria are met:
At least three days have passed since symptom onset (or since a positive test result if asymptomatic).
*Day 0 is the first day of symptoms or the first positive test if asymptomatic
AND
BOTH of the following have been true for at least 24 hours:
- Fever-free without the use of fever-reducing medication.
- Symptoms are improving and HCP feels well enough to work.
Upon returning to work, personnel should do the following:
- Wear source control (masking) through the end of day 10.
- Strictly adhere to hand hygiene, respiratory hygiene, and cough etiquette.
*Day 0 is the first day of symptoms or the first positive test if asymptomatic
Key information in the FAQ
The DOH FAQ expands on guidance related to the following:
- Return-to-work criteria
- Caring for high-risk populations
- Source control and mask effectiveness
- Mask replacement practices
- Other preventive measures.
Pertinent to the decision to return to work is the employee’s fitness-for-duty assessment. For example, if on day four the nurse’s symptoms have improved but they do not feel ready to safely perform their duties throughout the shift, they should remain off work.
While reducing prolonged absences and addressing workforce strain are important considerations, every nurse must make an independent, professional decision about their readiness to resume work. This decision should be free from undue pressure to ensure patient safety and protect caregiver well-being.