Guidance

[Withdrawn] COVID-19: management of staff and exposed patients or residents in health and social care settings

Updated 1 April 2022

This guidance was withdrawn on

This guidance is no longer in use.

Information for healthcare staff is available at COVID-19: managing healthcare staff with symptoms of a respiratory infection.

Information on managing patients is available at COVID-19: infection prevention and control (IPC).

Information for staff and residents in adult social care is available at COVID-19 testing for adult social care services.

What has changed

There is no longer a legal requirement for people with coronavirus (COVID-19) infection to self-isolate, however the public health advice for people with any of the main symptoms of COVID-19 or a positive test result is to stay at home and avoid contact with other people. Due to the higher risk nature of health and social care settings, the advice for staff members working in these settings has not changed.

1. Scope

This guidance is for staff and managers in health and social care settings and includes:

  • guidance for health and social care staff if they develop any of the main COVID-19 symptoms, receive a positive LFD or PCR test result or are identified as a contact of a COVID-19 case
  • guidance on isolation requirements for patients and residents in health and social care settings after contact with COVID-19 cases
  • guidance on repeat testing for COVID-19 for staff, patients and residents in health and social care settings

There is separate guidance on investigation and clinical management of possible cases.

Guidance for stepdown of infection control precautions and discharging COVID-19 patients and asymptomatic SARS-CoV-2 infected patients and Admission and care of residents in a care home during COVID-19 provide information specific to hospital and care home settings respectively, including isolation requirements following positive COVID-19 test results and for contacts of COVID-19 cases.

This guidance has been written by the UK Health Security Agency (UKHSA) with input from NHS England and is primarily for health and social care management and staff in England. Country specific advice may be available for each country across the United Kingdom. Please refer to Health Protection Scotland, Public Health Wales, or Public Health Agency in Northern Ireland.

2. Guidance for staff who have COVID-19 symptoms or a positive test result

Staff who have received one or more doses of COVID-19 vaccine and who have any of the main symptoms of COVID-19, or have received a positive LFD or PCR test result, should still follow this guidance. This is because it is still possible to get COVID-19 and spread it to others, even if you are fully vaccinated[footnote 1].

2.1 If a staff member develops COVID-19 symptoms

The main symptoms of COVID-19 are recent onset of any of the following:

  • a new continuous cough
  • a high temperature
  • a loss of, or change in, your normal sense of taste or smell (anosmia)

For most people, COVID-19 will be a mild illness. However, if any member of staff has any of the symptoms listed above, even if those symptoms are mild:

  • they are advised to stay at home and arrange to have a PCR test
  • if at home (off-duty), they should not attend work while awaiting their PCR test result and should notify their employer or line manager immediately
  • if at work, they should inform their employer or line manager and return home as soon as possible

There are several other symptoms linked with COVID-19. Any of these symptoms may also have another cause. If staff members are concerned about their symptoms, they should seek medical advice.

2.2 If a staff member receives a positive LFD or PCR test result

Anyone who receives a positive LFD or PCR test result should stay at home and avoid contact with other people. There is no need to take a PCR test after a positive LFD test result.

Health and social care staff with COVID-19 should not attend work until they have had 2 consecutive negative LFD test results (taken at least 24 hours apart), they feel well, and they do not have a high temperature. The first LFD test should only be taken from 5 days after the day their symptoms started (or the day their test was taken if they did not have symptoms) - this is described as Day 0. If both LFD tests results are negative they may return to work immediately after the second negative LFD test result, provided they meet the criteria below:

  • the staff member’s symptoms have resolved, or their only symptoms are cough or anosmia which can last for several weeks
  • if the staff member works with patients or residents who are especially vulnerable to COVID-19 (as determined by the organisation), a risk assessment should be undertaken, and consideration should be given to redeployment until period10 days after their symptoms started (or the day their test was taken if they did not have symptoms)
  • the staff member should continue to undertake daily LFD tests until 10 days after their symptoms started (or the day their test was taken if they did not have symptoms). For example:
    • if the first negative LFD test was taken on the fifth day, and the second negative LFD test was taken on the sixth day, they can return to work but should continue to take LFD tests on days 7, 8, 9 and 10
    • if the first negative LFD test was taken on the sixth day and the second negative LFD test was taken on the seventh day, they can return to work but should continue to take LFD tests on days 8, 9 and 10
  • if any of these LFD test results are positive the staff member should isolate and should wait 24 hours before taking the next LFD test
  • on days the staff member is working, the LFD test should be taken prior to beginning their shift, as close as possible to the start time
  • the staff member must continue to comply with all relevant infection control precautions and personal protective equipment (PPE) must be worn properly throughout the day

The likelihood of a positive LFD test in the absence of a high temperature after 10 days is low. If the staff member’s LFD test result is positive on the 10th day, they should continue to take daily LFD tests, and can return to work after a single negative LFD test result.

The likelihood of a positive LFD test after 14 days is considerably lower. If the staff member’s LFD test result is still positive on the 14th day, they can stop testing and return to work on day 15. If the staff member works with patients or residents who are especially vulnerable to COVID-19 (as determined by the organisation), a risk assessment should be undertaken, and consideration given to redeployment.

Managers can undertake a risk assessment of staff who test positive between 10 and 14 days and who do not have a high temperature, with a view to them returning to work depending on the work environment.

Any staff member admitted to hospital with COVID-19 symptoms will be subject to the guidance for isolation for patients within guidance for stepdown of infection control precautions and discharging COVID-19 patients.

There is additional guidance on reducing the spread of COVID-19. Household contacts of the staff member should also follow this guidance.

2.3 If a staff member receives a negative or inconclusive PCR test result

Staff who had symptoms of COVID-19 and who received a negative PCR test result can return to work providing they are medically fit to do so, subject to discussion with their line manager or employer and a local risk assessment.

Staff who receive an inconclusive PCR test result should not attend work and should arrange another PCR test. If this repeat PCR test result is positive they should follow the advice in section 2.2. If their PCR test result is negative they can return to work.

3. Guidance for staff who are contacts of someone with COVID-19

If a staff member is providing care to or is in close contact with an individual with COVID-19 infection and is wearing the correct PPE appropriately in accordance with the UK infection prevention and control (IPC) guidance and How to work safely guidance, they will not be considered as a contact for the purposes of contact tracing and isolation. This applies regardless of the vaccination status of the staff member.

If there has been a breach of recommended PPE during the care episode then the staff member would be considered a contact and should follow the advice below.

In non-patient facing areas, IPC precautions may unintentionally be less stringently adhered to – if IPC precautions have been compromised, or PPE has been worn incorrectly or breached, the staff member should be considered a contact and follow the advice below.

3.1 Staff members who are contacts of someone who has COVID-19

Staff members who are a contact of a confirmed COVID-19 case should inform their line manager or employer immediately if they are required to work in the 10 days following their last contact with the case.

If the staff member develops symptoms of COVID-19 during this period, follow the guidance in section 2.1.

The majority of health and social care staff who are contacts will be able to continue in their usual role. The following apply to staff returning to work:

  • the staff member should not have any of the main COVID-19 symptoms
  • the staff member should immediately arrange to have a PCR test and the result of this PCR test should be negative prior to returning to work
  • if a staff member has had COVID-19 infection in the past 90 days, they should not have a PCR
  • following the negative PCR result, the staff member should undertake an LFD test every day for the 10 days following their last contact with the case (even on days they are not at work)
  • on days the staff member is working, the LFD test should be taken before starting their shift, and the result should be negative
  • the staff member should comply with all relevant infection control precautions and PPE should be worn properly throughout the day
  • if the staff member works with patients or residents who are especially vulnerable to COVID-19 (as determined by the organisation), a risk assessment should be undertaken, and consideration given to redeployment during the 10 days following their last contact with the case

If any of the above cannot be met, the staff member should not come to work and should follow the People with COVID-19 and their contacts guidance.

4. Isolation requirements for patients and residents in health and social care settings after exposure to a case of COVID-19

4.1 Isolation requirements for inpatients who are identified as contacts of a case of COVID-19

Inpatients who are known to have been exposed to a confirmed COVID-19 case (contacts) should be isolated or should be cohorted (grouped together) with other similarly exposed patients who do not have COVID-19 symptoms, until 10 days after last exposure if they remain in hospital.

There is a small residual risk of developing COVID-19 after 10 days following exposure to a confirmed case. As an additional precaution, a risk assessment should be undertaken regarding the need to continue isolation from 11 to 14 days after exposure. This risk assessment should take into account factors such as the nature and extent of exposure, vaccination status (including booster status) of the contact, the ward environment which the individual is being transferred to and the risk of contact with patients at higher risk of severe illness if infected with COVID-19. There should be strict adherence to the IPC guidance.

If inpatient contacts are being discharged to a care setting during their contact isolation period, the care home should be informed of their status as a contact before discharge and this should be clearly described in the discharge summary. Refer to admission and care of residents in a care home during COVID-19 for further information on duration of self-isolation period for care home residents. If inpatient contacts are discharged to their own home, they and their household should be advised to follow the government guidance on staying safe and preventing spread.

If an inpatient contact develops symptoms consistent with COVID-19 during their contact isolation period, diagnostic tests including a PCR test for COVID-19 should be performed and isolation continued.

If the COVID-19 PCR test result is positive, follow the guidance for stepdown of infection control precautions and discharging COVID-19 patients and asymptomatic SARS-CoV-2 infected patients which includes information on isolation requirements. All the patients they have been cohorted with will need to re-start their isolation period from the date of their last exposure to this newly diagnosed case. This includes patients who are discharged to a care home facility.

4.2 Isolation requirements for residents of social care settings who are identified as contacts of a case of COVID-19

Residents who are known to have been exposed to a confirmed COVID-19 case (contacts) should be isolated or cohorted for up to 10 days following their exposure to a COVID-19 case. If they are cohorted, this should only be with other residents who do not have COVID-19 symptoms but who have also been exposed to a confirmed COVID-19 case. This also applies to residents who have previously recovered from COVID-19.

Residents may be able to end their self-isolation earlier than 10 days subject to a risk assessment and negative LFD test results. Refer to the guidance on admission and care of residents in a care home during COVID-19 (section 1.8) for further information.

If residents develop symptoms consistent with COVID-19 during the 10-day isolation period, PCR testing for COVID-19 (along with any testing for other potential diagnoses) should be performed.

If a contact who has been cohorted with other residents subsequently tests positive for COVID-19, all the residents they have been cohorted with will need to re-start their isolation period from the date of their last exposure to the newly diagnosed case.

5. Repeat testing for COVID-19

5.1 Exemptions from routine testing for individuals who have previously tested positive for COVID-19 within 90 days

Fragments of inactive virus can be persistently detected by PCR in respiratory tract samples following infection, and for some time after a person has completed their isolation period and is no longer infectious.

Asymptomatic staff, patients and residents who do not have severe immunosuppression, and who have previously tested positive for COVID-19 by LFD or PCR test should be exempt from routine testing by PCR test within 90 days from their initial illness onset or test date.

This does not apply if they:

  • develop new COVID-19 symptoms
  • are required to take a PCR test upon entry into the UK

This exemption includes patients without severe immunosuppression, who require routine testing within 48 hours prior to discharge to a care home. However, any hospitalised care home resident who tests positive and is being discharged within their 10-day isolation period should only be discharged to a designated setting.

5.2 Assessment of repeat PCR positive test results within 90 days of a prior positive test

If an individual is re-tested by PCR within 90 days from their initial illness onset or prior positive COVID-19 test and the PCR test result is positive, a clinical risk assessment should be used to decide whether new infection (‘reinfection’) is a possibility and to inform subsequent action including whether isolation is required.

Guidance on reinfection and performing clinical risk assessment is detailed in the Investigation and management of suspected SARS-CoV-2 reinfections: a guide for clinicians and infection specialists.

The advice of an infection specialist should be sought to inform clinical risk assessment.

5.3 Routine testing with LFD tests within 90 days of a prior positive test

If a staff member has returned to work after testing positive for COVID-19, they should resume routine LFD testing, even if this is within 90 days of the positive COVID-19 test result. If staff, patients or residents are tested with an LFD test within 90 days of a prior positive LFD or PCR test and the result is positive, they should start a new period of self-isolation (see section 2.2), unless a clinical or risk assessment suggests that a re-infection is unlikely. This risk assessment should inform subsequent action including whether isolation is required.

Guidance on reinfection and performing clinical risk assessment is detailed in the Investigation and management of suspected SARS-CoV-2 reinfections: a guide for clinicians and infection specialists.

The advice of an infection specialist should be sought to inform clinical risk assessment.

5.4 Isolation requirements for repeat positive test results 90 days or more after a prior positive test

If an individual is re-tested by LFD or PCR 90 days or more after their initial illness onset or prior test date, and is found to be positive, this should be considered as a possible new infection. They should isolate from when their symptoms started or their test date if they do not have symptoms, and follow People with COVID-19 and their contacts. Reinfection should be considered and further management including need for isolation assessed according to guidance on the investigation and management of suspected SARS-CoV-2 reinfections.

6. Associated legislation

This guidance is of a general nature and employers should consider the specific conditions of each individual place of work and comply with all applicable legislation, including the Health and Safety at Work etc. Act 1974.

  1. Fully vaccinated: 14 days after having received 2 doses of an approved vaccine (such as Pfizer-BioNTech, AstraZeneca or Moderna/Spikevax) or one dose of the single-dose Janssen vaccine