ADVISORY: Long Term Care Facility Respiratory Outbreak Guidance – September 2026

Dear Colleagues,

We hope this message finds you well. With respiratory season approaching, Benton County Health Department is sharing the current Oregon Health Authority (OHA) respiratory guidance with our long-term care facilities (LTFCs) partners. Please note that this guidance is provisional and subject to change. If/when there are relevant changes to the respiratory reporting guidelines, then Benton County Health Department will inform our LTCF colleagues. Additionally, the reporting guidelines for gastroenteritis (GI; e.g., norovirus) outbreaks remain two or more cases within a 7-day period.

Respiratory Outbreak Reporting

LTCF outbreak reporting is based upon meeting thresholds defined by the Oregon Health Authority (OHA) Respiratory Disease Outbreak Investigative Guidelines (December 2025). LTCFs should report outbreaks to the Benton County Health Department Communicable Disease (CD) Program when the following threshold is met within a 7-day period:

• 3 or more respiratory cases* (e.g., COVID-19 [Covid], Influenza [Flu], and/or Respiratory Syncytial Virus [RSV]); and
• ≥ 10% residents or staff affected

*Note: Cases can be confirmed or presumptive. Confirmed Case: lab confirmation, including point of care test; Presumptive Case: no lab confirmatory but similar symptoms & linked to a confirmed case. Please round your threshold percentages up or down to the nearest whole number.

As a general recommendation, when in doubt, report it out.

Return to Work Guidance for Healthcare Personnel (HCP)

LTCF return to work guidance for HCP is based on acute respiratory illness. As defined by OHA, suspect or confirmed acute respiratory illness includes two or more of the following symptoms: fever, cough, runny nose, nasal congestion, or sore throat. Please consider the following recommendations for deciding when LTCF HCP can return to work.

OHA Return-to Work Guidance for HCP 

• Do not return to work until: 
  • At least 3 days have passed since symptom onset (Day 0 = first day of symptoms), and 
  • at least 24 hours fever-free without fever-reducing medication, and 
  • Symptoms are improving and the individual feels well enough to work. 
• Wear a well-fitting facemask for source control in all patient care and common areas (e.g., breakrooms) for 10 days after symptom onset. 

Asymptomatic HCP with a positive test 

• Wear a well-fitting facemask for source control for 10 days after the first positive test.  
• Employers may consider excluding asymptomatic HCP from work for 3 days after the first positive test. 

Additional Notes 

• Testing is not required to return to work. 
• HCP should stay up to date on influenza and other recommended immunizations and follow facility policies for source control masking.  

Isolation Guidance for Residents

The current respiratory isolation guidance for residents is based upon the disease etiology. This guidance provides isolation recommendations for Covid and flu.

Covid Isolation

• 10-Day Isolation
  • Day 0 = First Day of Symptoms or Date of Positive Test

Flu Isolation

• 7-Day Isolation
  • Day 0 = First Day of Symptoms or Date of Positive Test

If a resident is co-infected, please consider the longest isolation duration. This can help prevent the spread of respiratory infections, limit the outbreak duration, and protect the residents’ health. For other respiratory disease isolation guidance, please contact the Benton County CD Program.

Vaccine Clinic Considerations

Please consider scheduling a vaccine clinic for your LTCF. Local pharmacies can assist with vaccine clinics.  To receive support with the coordination of LTCF vaccination clinics, please email Benton County’s Immunization Program (IZ).

The IZ Email is shared by all immunization team members. An IZ team member will respond to messages and provide support.

LTCFs can also call the Benton County IZ Program Coordinator’s desk phone directly.

Respiratory Surveillance Dashboards

OHA’s respiratory surveillance dashboards are available to the public. They are reliable sources of information to consider for respiratory disease tracking in Oregon. OHA’s dashboards can be reviewed here: Oregon’s Respiratory Virus Data: COVID-19, Influenza, RSV, Measles.

Public Health Communicable Diseases Oregon Administrative Rules (OARs) 

• OAR 333-018-0000 (Reporting Responsibilities) 
• OAR 333-018-0015 (What and When to Report) 
• OAR 333-019-0000 (Investigation of Reportable Diseases) 
• OAR 333-019-0002 (Cooperation with Public Health Authorities) 
• OAR 333-019-0003 (Providing Information) 
• OAR 333-019-0010 (School, Child Care, and Worksite Restrictions) 

The complete list of Public Health OARS can be found at: Oregon Health Authority Public Health Divisions – Chapter 333.

Thank You

Benton County Health Department is expressing our genuine appreciation to all working and/or living within our LTCF communities. Thank you for your dedication to the health of LTCF residents, staff, and visitors.