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This publication is available at https://www.gov.uk/government/publications/covid-19-management-of-exposed-healthcare-workers-and-patients-in-hospital-settings/covid-19-management-of-exposed-healthcare-workers-and-patients-in-hospital-settings
This guidance is intended for staff and managers in health and social care settings and includes:
- guidance relating to health and social care staff if they develop coronavirus (COVID-19) symptoms, receive a positive 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 available.
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 SARS-CoV-2 polymerase chain reaction (PCR) results.
This guidance was written by Public Health England (PHE) primarily for a health and care professional audience 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 health and social care staff on COVID-19 symptoms, test results and being identified as a contact of a case
All staff who come into contact with COVID-19 cases – whether or not they are protected by the use of personal protective equipment (PPE) or by other factors – should remain vigilant to the possibility of contracting infection, and should follow the guidance in this document if they develop symptoms.
Staff who are contacted by NHS Test and Trace should not assume that this relates to exposures in their workplace and must follow instructions on isolation.
2.1 If a staff member develops COVID-19 symptoms
If a health or social care staff member develops any of the 3 main symptoms of COVID-19, however mild:
- if at home (off-duty), they should not attend work 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
- they should follow the stay at home guidance and arrange to have a PCR test either through their workplace arrangements or the NHS Test and Trace service, as soon as possible (testing is most sensitive within 3 days of the development of symptoms)
2.2 If a staff member receives a positive SARS-CoV-2 PCR test result
When a staff member receives a positive SARS-CoV-2 PCR test result, they must self-isolate for 10 days. The isolation period includes the day the symptoms started or the day their PCR test was taken if they do not have symptoms, and the next 10 full days. Their household contacts should follow the stay at home guidance and self-isolate from when the staff member’s symptoms started or from the date of the PCR test if asymptomatic. Household contacts who also work in health and social care may be exempt from self-isolation under very specific circumstances (see section 2.5).
Any staff 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.
2.3 If a staff member receives a positive SARS-CoV-2 self-reported lateral flow device (LFD) antigen test result
If a staff member’s self-reported SARS-CoV-2 LFD antigen test result is positive, they and their household should self-isolate immediately. They should arrange to have a follow-up PCR test as soon as possible, either through their workplace arrangements or the NHS Test and Trace service. If the follow-up PCR test result is negative, they and their household can stop isolating.
2.4 Returning to work criteria
2.4.1 If staff are symptomatic
Staff who receive a negative PCR test result can usually 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 a positive PCR test result can return to work after their isolation period has ended (see section 2.2), provided their symptoms have improved, they have been afebrile (not feverish) for 48 hours without the use of medication to control fever, and are medically fit to return. Staff may still return to work if they still have a cough or a loss of or a change in normal sense of smell (anosmia) or taste, as these symptoms may persist for some time after the infection has resolved.
Staff who receive an inconclusive PCR test result should continue to self-isolate and arrange another PCR test. They can return to work after their isolation period has ended (see section 2.2).
2.4.2 If staff are asymptomatic
Staff who test positive for SARS-CoV-2 (either by PCR or a self-reported LFD antigen test followed by PCR) and who were asymptomatic at the time of the test can return to work after their isolation period ended (see section 2.2) if they remain well. However, if they develop symptoms during the 10 days isolation, they should self-isolate for 10 full days from the day of symptom onset. They can return to work after 10 days, subject to improvement of symptoms outlined above.
2.5 If a staff member is identified as a contact of a COVID-19 case
If a staff member is identified as a contact of a person with COVID-19, for example by the NHS Test and Trace service or their workplace, they must isolate for 10 days, irrespective of a negative PCR test result.
If the staff member develops symptoms of COVID-19 during this period they should arrange to have a PCR test either through the their workplace arrangements or NHS Test and Trace service. If their test result is positive, they should start a further full 10 day isolation period beginning when their symptoms started, regardless of where they are in their original 10 day isolation period. This means that their total isolation period will be longer than 10 days.
2.5.1 Exemptions from contact isolation in health and social care settings
A local risk assessment should be performed to inform workplace contact tracing in health and social care settings. The following general principles apply:
if health and social care staff are providing care to or are in close contact with an individual with COVID-19 infection and are wearing the correct PPE appropriately in accordance with the current infection prevention and control (IPC) guidance, they will not be considered as a contact for the purposes of contact tracing and isolation
if there has been a breach of recommended PPE during the care episode then the staff member would be considered a contact and self-isolation would be required for 10 days
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
2.5.2 Exceptional exemptions from self-isolation for critical staff
If there is a likelihood that staff absence creates a significant risk to the health or safety of patients or service users, health and social care staff whose activities are critical to the ongoing provision of care and who have been identified as a contact of a case of COVID-19 may be able to attend work rather than self-isolate if they are fully vaccinated (more than 14 days after the second dose).
This may only occur in exceptional circumstances and where additional safety measures can be upheld. The decision is subject to a risk assessment and subsequent authorisation by an individual(s) nominated by the organisation’s management and a locally agreed multi-agency arrangement. Healthcare and care providers should check with their Director of Infection Prevention and Control, Director of Public Health, health protection team (HPT), clinical commissioning group or relevant local authority commissioner about these arrangements.
In order to mitigate the increased risk associated with this exemption, the following should apply:
- the staff member should only attend work after having a negative PCR test and daily LFD antigen tests
- the staff member should remain free of COVID-19 symptoms
- the staff member should comply with all relevant infection control precautions and PPE should be properly worn throughout the day
- the staff member should not work with clinically extremely vulnerable patients or residents, as determined by the organisation
- outside of work activities, the staff member must follow current advice for self-isolation
3. Isolation requirements for patients and residents in health and social care settings after exposure to a case of COVID-19
3.1 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 while in hospital should be isolated or cohorted (grouped together) with other similarly exposed patients who do not have COVID-19 symptoms, until 14 days after last exposure if they remain in hospital. If discharged to care settings, they should be advised to remain isolated from others for the remainder of their 14 day exposure window. On discharge to their own home, patients should be advised to stay at home until 10 days have elapsed since their exposure and should refer to guidance for non-household contacts.
This also applies to inpatients who have previously recovered from COVID-19 and have been exposed to a confirmed COVID-19 case during their hospital stay.
If symptoms or signs consistent with COVID-19 occur in the 14 days after exposure then relevant diagnostic tests, including for SARS-CoV-2, should be performed. If they test positive for SARS-CoV-2, then all the patients they have been cohorted with will need to re-start their 14 day isolation period from the date of their last exposure to newly diagnosed case.
If a SARS-CoV-2 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.
3.2 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 should be isolated or cohorted (only with residents who do not have COVID-19 symptoms but who have also been exposed to a confirmed COVID-19 case) for 14 days after their last exposure to a case. This also applies to residents who have previously recovered from COVID-19 and have been exposed to a confirmed COVID-19 case.
If symptoms or signs consistent with COVID-19 develop in residents in the 14 day period since last exposure, then testing for COVID-19 (along with any relevant testing for other potential diagnoses) should be performed. If individuals who have been cohorted with other residents subsequently test positive for SARS-CoV-2, then all the residents they have been cohorted with will need to re-start their 14 day isolation period from the date of their last exposure to newly diagnosed case.
Guidance on admission and care of residents in a care home during COVID-19 provides further information relating to the care home setting including requirements for isolation of residents with a positive PCR result.
4. Repeat testing for COVID-19
4.1 Exemptions from routine testing for individuals who have previously tested positive for SARS-CoV-2 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.
Staff, patients and residents who do not have severe immunosuppression, and who previously have tested positive for SARS-CoV-2 by PCR, should be exempt from routine re-testing, by PCR or LFD antigen tests, if within 90 days from their initial illness onset or test date (if asymptomatic), unless they develop new COVID-19 symptoms.
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 14 day isolation period should only be discharged to a designated setting.
4.2 Assessment of repeat 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 PCR test date and their test is positive, a clinical risk assessment should be used to decide whether new infection (‘re-infection’) 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.
If staff are re-tested with an LFD antigen test within 90 days of a positive PCR test and are found to be positive, they and their household should self-isolate and they should arrange to have a follow-up PCR test. If the PCR is negative, they and their household can stop isolating.
4.3 Isolation requirements for repeat positive test results 90 days or more after a prior positive test
If an individual is re-tested 90 days or more after their initial illness onset or prior test date, and is found to be PCR positive, this should be considered as a possible new infection. They and their household should immediately self-isolate from when their symptoms started or their test date if they do not have symptoms, and follow stay at home guidance. 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.
5. 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 and the Health Protection (Coronavirus, Restrictions) (Self-Isolation) (England) Regulations 2020/1045.