Guidance

Managing flu, COVID-19 and other acute respiratory infections (ARI) in prisons and other prescribed places of detention (PPDs)

Updated 27 October 2026

Applies to England

Main messages

This guidance covers influenza (flu), COVID-19 and other acute respiratory infections (ARIs) across adult prisons and places of prescribed detention (PPDs). It is drawn upon the best available evidence and experience base and is intended as a basis for consistent practice nationally, while also accounting for local resources and needs.

The main actions and recommendations within this guidance are to:

• offer and encourage all eligible residents’ flu, COVID-19 and respiratory syncytial virus (RSV) vaccinations
• encourage all eligible staff to get flu, COVID-19 and RSV vaccinations
• follow the guidance for people with symptoms of a respiratory infection including COVID-19 if prisoners, detainees or staff have symptoms of ARI and a high temperature or do not feel well
• if an outbreak is not suspected, but individuals have symptoms of ARI, only test for COVID-19 if the symptomatic individual is eligible for COVID-19 treatments
• if an outbreak is suspected, contact the health protection team (HPT), who will advise on the use of multiplex polymerase chain reaction (PCR) testing for linked cases with most recent symptom onset. This is subject to local or regional arrangements. Please consult your local HPT for further information.
• confirmed cases of flu or COVID-19 should avoid contact with other people
• consider the wider impacts on prisoners/detainees, staff, and the setting when recommending outbreak control measures

There is separate guidance for preventing and managing outbreaks of ARI in the children and young people’s secure estate.

What has changed

In the most recent update to this guidance, there has been an:

• update to incorporate relevant additional considerations for preventing and managing ARIs in prisons and other prescribed places of detention. These include additional considerations on isolation, ventilation, infection prevention and control, visiting, contact restrictions and outbreak control measures.

Who this guidance is for

This guidance provides operational recommendations to assist residential and healthcare staff, commissioners and providers in the adult estate, and UK Health Security Agency (UKHSA) HPTs.

This guidance describes measures to prevent and manage cases and outbreaks of ARI in these settings. Operational practices may vary due to setting specific considerations.

NHS commissioned services should also refer to the NHS England National infection prevention and control manual (NIPCM) for England.

Background

PPDs are considered higher risk for transmission of ARI and poor outcomes because:

• large numbers of people live close together with high degrees of social mixing
• the population is constantly changing with new receptions (people coming into the PPD), releases and transfers
• people in PPDs have a higher prevalence of chronic respiratory disease (including asthma), immunosuppression (for example, due to HIV infection) and other chronic illnesses (such as cardiovascular disease, diabetes, or liver disease) than their peers in the community
• staff who regularly move between the community and PPDs are a potential source of infection between the settings.

Most people with ARI will have a relatively mild illness, especially if they have been vaccinated. However, the risk of serious illness from flu and COVID-19 is higher among:

• people with underlying health conditions (such as chronic respiratory disease, diabetes, cardiovascular disease)
• older people
• those who are pregnant
• babies under 6 months of age
• those whose immune system means they are at higher risk of serious illness

People in PPDs should receive healthcare equivalent to people in the community. This includes access to flu, COVID-19 and RSV vaccination and treatments in line with National Institute for Health and Care Excellence (NICE) guidance, UKHSA guidance and NHS England commissioning.

As well as the clinical and public health considerations, minimising the impact of ARI outbreaks on the operational effectiveness of PPDs is essential to preserving a fully functional criminal justice and immigration removal system.

To reduce the impact of ARIs in PPDs there should be a whole-setting approach, including prevention, early identification and notification, and timely access to treatment and prophylaxis (where applicable).

Preventing transmission should be achieved through a combination of complementary measure including vaccination, prompt identification and management of cases, hand and respiratory hygiene, ventilation, environmental cleaning and proportionate operational measures where required. Measures should be proportionate to the level of risk and implemented in a way that maintains access to healthcare and minimises unintended impacts on prisoners and detainees, particularly those at increased risk of severe illness.

Definitions

Acute respiratory infections

The term ARI includes presentations both of influenza-like illness (ILI) and other acute viral respiratory infections.

Causes of ARI include SARS-CoV-2, the virus that causes COVID-19, influenza virus, RSV, adenovirus, rhinovirus, parainfluenza and human metapneumovirus (hMPV).

Influenza-like illness

Influenza-like illness (ILI), which can be caused by a variety of infectious agents, is a clinical diagnosis made on the basis of symptoms. The UKHSA definition of ILI is:

• an oral or ear temperature of 37.8°C or higher

And:

• acute onset of at least one of the following acute respiratory symptoms:
  • cough (with or without sputum)
  • hoarseness
  • nasal discharge or congestion
  • shortness of breath
  • sore throat
  • wheezing
  • sneezing

Outbreak of acute respiratory infections

An outbreak of ARI is defined as 2 or more epidemiologically linked cases within 5 days.

Vaccination

Vaccination helps to prevent serious illness associated with some respiratory infections.

Information and resources, including relating to ordering, prescribing and delivering vaccines can be found at:

• annual flu programme
• COVID-19 booster
• Green Book
• RSV vaccination programme

It is vital that healthcare staff not only protect themselves against flu and COVID-19, but also recognise the importance of vaccination as part of infection prevention and control and protecting the prisoners or detainees in their care.

Vaccination for prisoners and detainees

Healthcare teams should support eligible prisoners and detainees to access vaccinations via the NHS Make Every Contact Count and by using national and local promotional materials to encourage uptake and support access to vaccinations.

Healthcare providers should maximise opportunities to co-promote and co-administer vaccinations where possible and where clinically advised (for example COVID-19, flu, RSV vaccination), especially where this improves patient experience and uptake. However, waiting to co-administer should not unduly delay administration of any vaccine.

Healthcare teams should offer the RSV vaccination as per the RSV vaccination guidance. The vaccine should be offered to:

• all pregnant women from 28 weeks’ gestation
• everyone aged 75 years and over
• individuals aged 65 to 74 years who are immunosuppressed or have a chronic respiratory disease as defined in the RSV green book chapter

The RSV vaccine should be offered throughout the year as this is a year-round programme.

Vaccination for healthcare and custodial staff

All establishments’ local outbreak plans should include clear information on how all appropriate healthcare and custodial staff groups can access flu, COVID-19 and RSV vaccinations, and how employers will facilitate uptake.

Employers should encourage all staff to take up offers of flu, COVID-19 and RSV vaccination to protect themselves, their families and those they care for from severe illness.

Flu vaccination for HMPPS staff

His Majesty’s Prison and Probation Service (HMPPS) offers an e-voucher scheme for flu vaccines or onsite flu clinics in public sector prisons for all HMPPS staff aged 18 to 64. Through the e-voucher scheme, HMPPS employees can book their flu vaccine at another outlet if required.

HMPPS staff aged 65 and over have access to the flu vaccine for free via the NHS flu vaccine scheme.

Flu vaccination for other staff

Private-sector PPDs should offer the annual flu vaccine to all custodial staff as part of their occupational health provision.

Sub-contracted employees and volunteers within PPDs should be encouraged to contact their own occupational services to find out how to access flu vaccinations.

COVID-19 vaccination for all staff

PPD staff who meet the national NHS eligibility criteria can access COVID-19 vaccination in the community via local vaccination services.

RSV vaccination for all staff

All staff who meet the eligibility criteria can access the RSV vaccination in the community via the local vaccination services.

Recognising and responding to cases of acute respiratory infections

All staff should be aware of the symptoms of ARIs and should report suspected cases to the healthcare team as soon as possible, ideally within 24 hours.

Custodial staff often have the most contact with prisoners and detainees, placing them in a good position to recognise symptoms among those in their care. Clinical advice should be sought from the healthcare team if the person is unwell or has a high temperature.

Symptoms of acute respiratory infections

For up-to-date information on the symptoms of respiratory infections, including COVID-19, flu, and other common ARIs, please refer to people with symptoms of a respiratory infection including COVID-19.

These symptoms include:

• continuous cough
• high temperature, fever or chills
• loss of, or change in, the normal sense of taste or smell
• shortness of breath
• unexplained tiredness, lack of energy
• muscle aches or pains that are not due to exercise
• not wanting to eat or not feeling hungry
• headache that is unusual or longer lasting than usual
• sore throat, stuffy or runny nose
• diarrhoea, feeling sick or being sick

Management of cases of acute respiratory infections

Staff, prisoners and detainees should be alert for signs and symptoms of ARI and know how to report these if they become unwell or develop a high temperature.

Prisoners, detainees and staff with symptoms of ARI and a high temperature or who do not feel well should follow the guidance for people with symptoms of a respiratory infection including COVID-19.

It is particularly important that people with a high temperature or feeling unwell with symptoms of ARI try to avoid close contact with anyone at higher risk of becoming seriously unwell, especially individuals who have weakened immune systems which means that they are at higher risk of serious illness.

If prisoners, detainees or staff are unable to avoid contact with other people while they have a high temperature or are feeling unwell and have ARI symptoms, there are actions that will reduce the chance of passing on the infection to others.

These include:

• wearing a well-fitting face covering made with multiple layers, or a surgical face mask
• covering mouth and nose when coughing or sneezing
• washing hands frequently with soap and water for 20 seconds, or using hand sanitiser, after coughing, sneezing and blowing their nose and before eating or handling food
• avoiding touching their face

Limiting the number of prisoners and detainees deployed in essential services and in enclosed or poorly ventilated environments, where indicated by a risk assessment. Measures should be in place for transportation to reduce the risk of the infection spreading.

If prisoners or detainees with symptoms of an ARI also have a high temperature or do not feel well enough to carry out normal activities, they should try to stay in their room and avoid contact with other people. They can return to usual activities when they no longer have a high temperature (if they had one) or when they no longer feel unwell.

Prisoners or detainees isolating from others should continue to have timely access to healthcare, prescribed medicines, mental health support and welfare services.

Establishments should also consider opportunities to support wellbeing, including access to fresh air, exercise and communication with family or legal representatives as operationally feasible.

Staff who have a high temperature or feel unwell and have symptoms of an ARI should try to stay at home, avoid contact with other people and report the absence to their employer. They can return to work when they no longer have a high temperature (if they had one) or when they no longer feel unwell.

More information on how to limit the spread of ARIs in PPDs is provided in the section on limiting the spread of ARI below.

Healthcare staff employed by the NHS or other healthcare providers should follow the NHS sickness absence toolkit 

Staff should be mindful of the potential for the infection to spread and for an outbreak to start.

Testing to identify the cause of infection

Testing for respiratory viruses is only recommended if it is required for clinical management (for example a prisoner or detainee is symptomatic and eligible for antivirals), or if there is an outbreak. If an outbreak is suspected, contact the local HPT who will conduct a risk assessment. The HPT will advise on the use of multiplex PCR testing for linked cases with most recent symptom onset, in accordance with local or regional arrangements (see the section on testing to identify the cause of infection in an outbreak for more information).

Prisoners or detainees eligible for COVID-19 treatments

Prisoners or detainees in the at-risk group for COVID-19 treatments who test positive for COVID-19 should be urgently referred to the local Integrated Care System’s (ICS) COVID-19 therapeutic service. The healthcare service should have a referral pathway in place for these cases. If the service access details are not known, NHS 111 can provide information for the referral to the local service.

The service will arrange for the prisoner or detainee to be assessed, prescribed and supplied with a COVID-19 treatment. Note that if the prisoner or detainee requires parenteral treatment, they will need to be urgently transferred to a hospital or clinic to receive this. Close collaboration between healthcare services and custodial teams is needed to facilitate a prompt transfer in these cases.

If all of the individual’s LFD test results are negative, they can return to their usual activities once they are well enough to do so, and they do not have a high temperature. If there are concerns about someone’s health, they should undergo clinical assessment.

Reporting COVID-19 test results for surveillance purposes

Under Regulation 4A of The Health Protection (Notification) Regulations 2010, PPDs are required to report positive, negative and void LFD test results where they have assisted prisoners or detainees to take an LFD.

To support PPDs in being able to meet their Regulation 4A duty, the UKHSA multiple registration spreadsheet will remain available for PPDs to report COVID-19 LFD test results. 

It is important to note that the registration of a positive COVID-19 LFD test result will not lead to a COVID-19 treatment being prescribed. To access COVID-19 treatments, follow the guidance issued by the NHS and refer positive at-risk patients to integrated care board (ICB) pathway.

Management of prisoners, detainees and staff with a positive test result for COVID-19 or flu

All PPDs should have a plan in place to identify appropriate facilities where prisoners and detainees who have tested positive for flu, COVID-19 or another ARI can be supported to isolate appropriately.

Confirmed cases of flu and COVID-19 should avoid contact with other people. Where possible, prisoners and detainees with confirmed flu or COVID-19 should be supported to isolate in single occupancy accommodation. See the cohorting cases section for guidance about cohorting in an outbreak.

Prisoners and detainees who are isolating away from others should receive regular welfare checks and have opportunities to discuss their wellbeing and any anxieties with healthcare staff. They should receive clear and accessible information about why isolation is required, how long it is expected to last, and how to access healthcare or additional support if needed.

If the health of a prisoner or detainee is worsening, or if they remain unwell after 10 days or longer, the PPD should arrange for the prisoner or detainee to get medical advice.

Duration of isolation (prisoners, detainees and non-healthcare staff)

Confirmed cases of flu should continue to isolate until their symptoms resolve (usually 3 to 5 days from onset but may be longer in people with underlying medical conditions).

Confirmed cases of COVID-19 should isolate for 5 days after the day the test was taken. They can return to normal activities after 5 days if they feel well enough and no longer have a high temperature. During any period of isolation, establishments should maintain access to healthcare, prescribed medicines, mental health support and welfare services. Where operationally feasible, they should also consider opportunities for individuals who feel well enough to access fresh air and exercise, and to maintain contact with family and legal representatives.

Healthcare staff cases

Healthcare staff employed by the NHS or other healthcare providers who have tested positive for COVID-19 should follow guidance on managing healthcare staff with symptoms of a respiratory infection, including COVID-19.

 Asymptomatic contacts

Where movement restrictions are introduced for close contacts, these should be proportionate to the assessed risk, time limited and regularly reviewed and discontinued when no longer required.

 Contacts of flu cases

Where there are 2 or more people in a cell and one has confirmed flu, custodial staff should isolate all cellmates if operationally possible, from the general population for 48 hours, starting from their last contact with the case to ensure the contact hasn’t acquired the infection. Contacts do not need to be tested. If they develop symptoms, they should be managed as a case (see the above section on the management of cases of acute respiratory infections).

Practical operational considerations, such as the number of spare cells available, will inform whether the cell-sharing prisoner or detainee stays in their current cell or is moved to another location away from the symptomatic cellmate.

If operationally possible, any cellmate with health vulnerabilities that make them eligible for the flu or COVID-19 vaccine should be removed from the cell of the symptomatic case.

Contacts of COVID-19 cases

There is no need for contacts of a case of COVID-19 to undertake testing. This applies to prisoners, detainees and staff. Routine contact tracing is not currently being undertaken in PPDs.

Close contacts of a confirmed case of COVID-19 should be supported to:

• minimise contact with the case
• avoid contact with anyone with a weakened immune system, which means they are at higher risk of serious illness, despite vaccination
• follow relevant guidance if they develop symptoms of COVID-19

If operationally possible, any cellmate with health vulnerabilities that makes them eligible for the flu or COVID-19 vaccine should be removed from the cell of the symptomatic case.

Limiting the spread of acute respiratory infections

There are actions that settings can take to limit the spread of ARIs. Operational practices may vary due to setting-specific considerations.

 Vaccination

As outlined in the above section on flu and COVID-19 vaccines, all eligible prisoners, detainees and staff are strongly encouraged to be vaccinated to protect themselves and others from flu, COVID-19 and RSV. This is especially important given the vulnerabilities of people in PPDs.

Vaccination for flu and COVID-19 is not effective for post-exposure prophylaxis due to the time taken for immunity to develop.

Ventilation

Bringing in fresh air to occupied spaces, while still maintaining appropriate levels of security, can help to reduce the concentration of respiratory particles, lowering the risk of respiratory viral infections being transmitted through the air.

Where mechanical ventilation systems are present, they should be maintained and operated in line with HMPPS/Home Office Health and Safety recommendations. Estates and facilities teams should be involved when considering opportunities to improve ventilation, while ensuring that any changes remain compatible with security and safety requirements.

See further guidance on how to ventilate indoor spaces.

Infection prevention and control

Hand and respiratory hygiene are important components of infection prevention and control (IPC) and essential to reduce cross-contamination and infection.

Information and visual reminders promoting hand and respiratory hygiene should be displayed throughout establishments where appropriate. Suitable hand-washing facilities should be available including running water, liquid soap and paper towels or hand driers. Where alcohol-based hand sanitiser cannot be provided because of security considerations, suitable alternative hand hygiene arrangements should be available.

Hands should be cleaned after removing personal protective equipment (PPE) or handling contaminated surfaces or laundry.

If a flu or COVID-19 case needs to pass through areas where other people are waiting, then they should wear a fluid repellent surgical mask (type IIR).

For further information, please refer to the Infection prevention and control guidelines for adult prisons.

Cleaning

During outbreaks, use chlorine-based products at 1,000 parts per million (ppm) available chlorine, or other products effective against respiratory viruses, to disinfect the environment, including shared areas. Products that contain both detergent and chlorine may be used to give a measured dose of chlorine in solution for a one-stage clean and disinfection. Frequently touched surfaces, such as door handles, light switches, work surfaces, remote controls and electronic devices, should be cleaned regularly with compatible cleaning products. This is especially true in communal bathrooms and communal kitchens.

During outbreaks, the cleaning schedules should be adjusted to increase the frequency of cleaning and decontamination processes, particularly frequent touch points. Staff undertaking enhanced cleaning should receive appropriate training and use suitable personal protective equipment in accordance with IPC guidance. For further information, please refer to the Infection prevention and control guidelines for adult prisons.

Waste

Waste visibly contaminated with respiratory secretions from a person with an ARI infection should be sealed in a waste bag before removal from the cell or room and placed into a waste bin as soon as possible. There is no need to store waste for a time before collection. Dispose of routine waste as normal.

Waste produced by healthcare should follow appropriate guidance in the National Infection Prevention and Control Manual from NHS England.

Hand hygiene should be performed after handling waste.

Laundry

Wash items in accordance with the manufacturer’s instructions. Use the warmest water setting and dry items completely.

Clothes, bedding, towels, or other laundry items that have been used by someone with an ARI can be washed with other people’s items. All used linen items should be removed one by one and placed with care into the dedicated used linen hamper or stream. To reduce the risk of self-contamination, do not shake used laundry prior to washing. Hand hygiene should be performed after handling used linen. For further information, please refer to the Infection prevention and control guidelines for adult prisons.

Visitors

Visitors should follow the guidance for people with symptoms of a respiratory infection including COVID-19 if they experience symptoms.

Where restrictions on visiting are necessary, these should be proportionate, regularly reviewed and implemented alongside other measures such as ventilation, hand hygiene and face masks where recommended in consultation with the local HPT. Alternative arrangements, such as remote visiting, should be considered to maintain family and legal contact.

Prisoners, detainees or visitors who are isolating because they have symptoms of an acute respiratory infection (ARI), or because they are a confirmed case of COVID-19, should be considered on a case-by-case basis. Decisions regarding participation in visits should be informed by a local risk assessment, taking into account the severity of symptoms, the risk of transmission, operational considerations, and the potential impact on the individual. Where visits are deferred, they may resume once symptoms have resolved and the relevant criteria for returning to normal activities have been met.

Outbreaks

Contacting the local health protection team

If an outbreak is suspected, staff should contact the local HPT as soon as possible.

The PPD should highlight to the HPT if there are specific issues of concern. For example, if there is a:

• high number of hospitalisations or unexpected deaths among prisoners or detainees
• rapid increase in the number of prisoners, detainees or staff with symptoms of an ARI
• suspected outbreak of another infection in addition to an ARI.

Outbreak control team

Following initial risk assessment by the HPT with the setting, the HPT may convene an outbreak control team (OCT) to support management and help coordinate the outbreak response.

Full details on how to manage an outbreak can be found in the Management of incidents and outbreaks of communicable disease in secure settings in England.

Testing to identify the cause of infection in an outbreak

It is important to identify the infection at an early stage of an outbreak to aid public health management, for example, to distinguish between COVID-19 and other ARIs such as flu. This will also ensure access to appropriate clinical care for those who need it.

If an outbreak is suspected, the HPT will advise on the use of multiplex PCR to test up to 5 linked cases with most recent symptom onset to establish which infection the individuals have.

Any individual who is eligible for COVID-19 treatments should also be tested as soon as possible if they develop symptoms of an ARI using COVID-19 LFD tests obtained for this purpose, even if they are also tested by PCR. Further testing of other symptomatic cases is not required unless testing is instructed by the local HPT.

If settings are advised to test in response to an outbreak, they will be expected to record the results and provide a summary to the HPT.    

If a flu outbreak is confirmed, the need for any additional testing will be considered by the HPT and/or an OCT.

Management of additional cases

During the outbreak, PPD and healthcare staff with ARI symptoms should be managed by their GP. They should seek testing for flu and/or COVID-19 based on the risk assessment of the OCT and their eligibility for COVID-19 treatments.

Antiviral treatment for flu

Healthcare staff should follow the guidance on the use of antiviral agents for the treatment and prophylaxis of seasonal influenza, supported by NICE guidance (TA168), for the treatment of individuals with flu.

HPTs can provide additional advice on the use of antivirals for the treatment of flu in an outbreak situation.

Antivirals should only be used for the treatment of flu in people in specific at-risk groups or those presenting with complications of flu.

In line with the above guidance, if someone with symptoms meets the criteria for receiving antivirals and the diagnosis of flu is considered to be highly probable based on the available clinical and epidemiological information, antivirals should be started promptly without awaiting the results of flu testing.

Antiviral post-exposure prophylaxis for close contacts of people with flu

Following advice from the HPT or the OCT, certain prisoners, detainees or staff may be offered antivirals for post-exposure prophylaxis (medicines taken soon after a possible exposure to flu) if they are close contacts of a flu case and are in a clinical risk group. Where there is an extensive outbreak, the OCT should consider offering antiviral post-exposure prophylaxis to all people in clinical risk groups in affected parts of the PPD.

Any recommendations for the use of antivirals as post-exposure prophylaxis should be in line with the guidance on the use of antiviral agents for the treatment and prophylaxis of seasonal influenza, supported by NICE guidance (TA158).

Prescribing and accessing flu antivirals

PPD winter plans should include details of the ordering and supply processes for flu antivirals. These plans must consider the need for patients to start antivirals within 48 hours of symptoms beginning (or within 48 hours of contact if being used for post-exposure prophylaxis).

Antivirals may be prescribed by issuing an individual prescription or a Patient Group Directive (PGD). Further information can be found in the Guidance on use of antiviral agents for the treatment and prophylaxis of seasonal influenza

PGDs can help healthcare staff quickly access antivirals. PGDs should only be used in line with legislation and NICE guidance on PGDs. 

Template PGDs for prescribing antivirals are available on GOV.UK. The templates were designed to be used in care homes, but they can be adapted for secure settings. The PGDs cover treating those with flu-like symptoms, and for prophylaxis for people at risk of getting flu and who meet specific criteria.

Antivirals for prisoners or detainees should be accessed from the PPD healthcare service or the service’s contracted pharmacy.

Any staff requiring antivirals should access these via their own GP and community pharmacy, or through occupational health.

Use an out of hours pharmacy for all urgent supplies.

During an outbreak, it is possible that individuals in at-risk groups may require antiviral prophylaxis over a prolonged period. Further details can be found in the NICE guidance.

Outbreak control measures

The decision to introduce any outbreak control measure must consider the potential for adverse impacts on the wellbeing, health and safety of prisoners, detainees and staff. Decisions should be informed by local risk assessment, current epidemiology, and operational considerations. Measures should be proportionate, targeted and time limited, and should be reviewed regularly to ensure they remain necessary while minimising any unintended impacts on wellbeing, rehabilitation and access to essential services.

In addition to the actions to limit the spread of ARI covered in limiting the spread of acute respiratory infections, measures which aim to limit person-to-person transmission of ARI include:

• reducing or stopping mixing between individuals from different wings or buildings, to prevent transmission between groups
• reducing or stopping communal activities
• reintroduction of social distancing
• cohorting staff to work on specific wings or buildings
• introduction of enhanced IPC and PPE measures being used in the setting, including the use of face coverings

Additional outbreak control measures are detailed in the sections below.

More information on managing outbreaks can be found in the multi-agency Management of incidents and outbreaks of communicable disease in secure settings. - GOV.UK (www.gov.uk).

Infection prevention and control

During outbreaks, the importance of hand and respiratory hygiene should be re-emphasised among prisoners, detainees, staff and visitors.

Staff should follow the stated IPC advice in the earlier section, which is specific to controlling the spread of ARI. Local stocks of PPE and suitable arrangements for safe disposal should be in place for this.

Follow the guidance on recommended PPE for staff in prisons and community offender populations.

During outbreaks, wider staff use of fluid repellent surgical masks (Type IIR) should be considered to reduce transmission of ARI’s, particularly in poorly ventilated or crowded areas. This is known as source control and prevents the spread from the wearer to others.

Enhanced cleaning

During outbreaks, chlorine-based products should be used to disinfect the environment. Products that contain both detergent and chlorine may be used to give a measured dose of chlorine in solution for a one-stage clean and disinfection. HMPPS has approved the procurement of chlorine-based products for use across the prison estate.

During outbreaks, the cleaning schedules should be adjusted to increase the frequency of cleaning and decontamination processes.

Laundry

Wash items in accordance with the manufacturer’s instructions. Use the warmest water setting and dry items completely.

Clothes, bedding, towels, or other laundry items that have been used by someone with an ARI can be washed with other people’s items. All used linen items should be removed one by one and placed with care into the dedicated used linen hamper or stream. To reduce the risk of self-contamination, do not shake used laundry prior to washing. Hand hygiene should be performed after handling used linen. For further information, please refer to the Infection prevention and control guidelines for adult prisons.

Visitors

Visitors should be made aware of outbreaks which are currently occurring prior to attending, so they are fully informed and can manage their own risk.

Visitors with underlying health conditions and those at risk of more severe infection (as described in both the chapter on flu in the Green Book and the chapter on COVID-19) should be discouraged from visiting during an outbreak.

Cohorting cases

Where demand for single cell accommodation exceeds capacity, cases may be ‘cohorted’ or paired together in a shared cell. People with confirmed flu should be cohorted separately from people with confirmed COVID-19, and both should be cohorted separately from confirmed cases of other ARIs.

Where cases are concentrated in a particular area or wing, the OCT might consider bringing all other cases into the same area and cohorting them, subject to operational and security assessment.

Population management

Where an ARI outbreak has been declared, the prison governor should inform the HMPPS Health Liaison Service by emailing health@justice.gov.uk who will notify the population management unit (PMU) and other headquarters (HQ) functions if required.

If an OCT is convened, the governor and the consultant leading the OCT should complete a dynamic risk assessment form.

The OCT can consider recommending restricting transfers out to other PPDs, restricting new receptions, or both. Before changing the operational status of the PPD, the OCT should consider whether it is proportionate and helpful to the management of the outbreak. If the OCT decides to go ahead with a recommendation, they should consider whether to recommend fully or partially limiting movement. They can ask for a governor’s advice on the potential impacts of any change. The OCT should then make the recommendation to HMPPS.

HMPPS will consider recommendations to restrict transfers to another PPD, transfer to court, and new receptions into a PPD at a regional level with reference to national population management and other HQ functions as required. HMPPS is responsible for deciding how to respond to an OCT recommendation to limit or stop receptions and transfers. HMPPS has oversight of the wider prison estate and how any such decisions will affect overall prison population management. Decisions to restrict transfers or receptions should balance the public health benefits of reducing transmission with the potential operational, healthcare and welfare impacts across the wider prison estate.

Lifting outbreak measures

Outbreak measures can be lifted 5 days after the last suspected or confirmed case.

Staff are recommended to remain alert for possible new cases between 6 to 10 days after the last suspected case.

As a precaution, infection control measures like hand washing, wearing PPE and social distancing can be maintained for longer than 10 days, if advised by the OCT.