Guidance

COVID-19 supplement to the infection prevention and control resource for adult social care

Updated 16 November 2023

Applies to England

Summary of changes

Guidance sections on ‘Treatments for people at higher risk of severe outcomes’ and ‘Ordering tests’ have been updated to reflect changes to accessing tests.

Tests for use by symptomatic individuals eligible for COVID-19 treatments should be accessed via the NHS, replacing the existing national ordering portal. Tests for outbreak testing in care homes can continue to be ordered from the national ordering portal.

Introduction

This guidance outlines COVID-19 infection prevention and control (IPC) measures for staff, service users and visitors in adult social care settings and services in England. This guidance should be read by adult social care providers, managers of social care services, adult social care staff, and by service users and visitors where relevant.

It includes advice on testing which was previously in the COVID-19 testing in adult social care guidance; this guidance has now been withdrawn.

As a result of protection by high vaccination coverage, high immunity amongst the population, and increased access to COVID-19 treatments, we are now in a position to manage COVID-19 increasingly like other respiratory infections.

In line with this approach, testing and IPC measures in this guidance are focused on protecting those most at risk of severe outcomes.

Vaccination

Vaccination remains a primary protection measure against both COVID-19 and flu, helping to reduce the risk of serious illness, hospitalisation and death.

It is important that all those who are eligible for vaccination take up their offers as soon as they become available, including health and social care workers, to help protect themselves and those around them.

Providers should take steps to support vaccination by:

• commencing the consent process for service users in good time to maximise uptake for eligible people in residential care settings
• encouraging staff to book their vaccinations as soon as offers become available
• providing information on vaccination campaigns with Q&A leaflets, posters, and stickers available on campaigns via the campaign resource centre

COVID-19 vaccines are offered during seasonal campaigns for those at high risk of serious disease from COVID-19 and who are therefore most likely to benefit from vaccination.

COVID-19 vaccines are also available for health and social care workers and carers to protect health and social care services from COVID-19 related staff absences over winter.

The latest information on COVID-19 vaccine campaigns is available on the NHS website.

Flu vaccination is also an important defence against severe outcomes caused by the flu virus and reduces the risk of co-infection with COVID-19 and flu. People who are at higher risk of flu associated morbidity and mortality, including older people and those in clinical risk groups, continue to be prioritised for vaccination.

Frontline social care workers, including both clinical and non-clinical staff who have contact with people with care and support needs, should also be offered a flu vaccination, when available, by their employer.    

Vaccination teams will contact providers to arrange visits. Care settings should commence the consenting process for residents, if not already done so. Adult social care staff are encouraged to book their vaccinations as early as possible via:

• local booking services from 11 September
• national booking service from 18 September

Eligible frontline staff will continue to be able to self-declare on the national booking service. Appointments can also be booked through the NHS App, or by phoning 119.

It is essential that all health and social care workers have the best protection against flu and COVID-19 as winter approaches. The flu jab and the COVID-19 vaccine remain the best defences we have against both viruses.

Flu vaccination reduces the risk of co-infection with COVID-19 and flu, and is therefore an important defence against severe outcomes. Separate advice on flu vaccination is also available.

Treatments for people at higher risk of severe outcomes

COVID-19 treatments

People who are at higher risk of severe outcomes from COVID-19 may be eligible for COVID-19 treatments if they become unwell.

People who are potentially eligible for COVID-19 treatments were previously digitally identified by their NHS records where possible. These individuals should have received a letter from the NHS explaining how to access COVID-19 treatments.

The process changed on 27 June 2023. Since June 2023, individuals who are newly eligible for access to free lateral flow device (LFD) tests should be made aware of eligibility by their doctor or specialist at the point they are diagnosed with a qualifying condition or start a qualifying treatment regimen.

If someone who is eligible for COVID-19 treatments develops symptoms of COVID-19, they should be tested as soon as possible with a LFD test. LFD tests taken to facilitate COVID-19 treatments should now be ordered via NHS routes, outlined in the section Ordering tests. If someone who may be eligible for COVID-19 treatments tests positive for COVID-19, providers should organise an assessment for COVID-19 treatments for them. See NHS guidance on COVID-19 treatments for more information.

Local NHS organisations are responsible for arranging COVID-19 treatments. The way people access treatments may depend on where they live. Please refer to your local integrated care board (ICB) for more information on local arrangements.

Treatments are most effective if started early and ideally provided within 5 days of symptom onset. It is therefore essential to test eligible people with symptoms as soon as possible so that they can access treatments in time if they test positive for COVID-19.

Staff providing care to people outside of residential care settings can help to support individuals to access tests and treatment for those eligible for COVID-19 treatments. More information is available at the NHS page on Treatments for COVID-19.

Flu antivirals

Information for clinicians on individual patient eligibility for flu antiviral treatment and prophylaxis is available at Influenza: treatment and prophylaxis using anti-viral agents.

Antivirals for the treatment and prevention of flu work best when people start them within 2 days of becoming unwell or being in close contact with a person with flu. Flu antivirals in care homes may be recommended by the health protection team (HPT) when multiple people develop symptoms of acute respiratory infection. Two or more linked cases of acute respiratory infection should be promptly notified to the UKHSA HPT to enable timely access to flu antivirals, if required. Refer to If 2 or more linked care home residents develop symptoms of a respiratory infection within 14 days for more information.

Staff or service users with symptoms of a respiratory infection, including COVID-19

Staff or service users who are eligible for COVID-19 treatments

Individuals who are eligible for COVID-19 treatments and who have symptoms of a respiratory infection should take an LFD test immediately and follow the guidance for people who are eligible for COVID-19 treatments.

If they have a high temperature or they feel unwell, they are advised to avoid contact with other people.

If the individual’s test results are all negative, they can return to their normal activities if they do not have a temperature and they feel well enough to do so.

If they receive a positive test result, they should also follow the guidance in the section on Staff or service users with a positive COVID-19 test result.

Staff or service users who are not eligible for COVID-19 treatments

Individuals who are not eligible for COVID-19 treatments no longer need to test if they develop symptoms of a respiratory infection.

Staff who have symptoms of a respiratory infection and are not eligible for COVID-19 treatments

Staff who have symptoms of a respiratory infection and who have a high temperature or do not feel well enough to go to work are advised to stay at home and avoid contact with other people. These staff members do not need to take an LFD test if they are symptomatic.

They should follow the guidance for people with guidance for people with symptoms of a respiratory infection including COVID-19.

Managers should undertake a risk assessment before staff return to work in line with normal return to work processes.

If these staff members receive a positive LFD test result for COVID-19, regardless of whether they have symptoms, they should follow guidance outlined in Staff or service users with a positive COVID-19 test result below.

Care home residents who have symptoms of a respiratory infection and not eligible for COVID-19 treatments

Care home residents who have symptoms of a respiratory infection and who have a high temperature or do not feel well enough to do their usual activities are advised to avoid contact with other people. They should be supported to stay away from others until they no longer have a high temperature or no longer feel unwell. These residents are not required to take an LFD test if they are symptomatic.

These residents are able to have at least one visitor during this time, with appropriate IPC precautions. Refer to the section on Visiting arrangements in care homes.

People receiving care outside of care homes who have symptoms of a respiratory infection and are not eligible for COVID-19 treatments

People receiving care at home who have symptoms of a respiratory infection and who have a high temperature or do not feel well enough to do their usual activities should follow the guidance for people with symptoms of a respiratory infection. They should avoid contact with other people until they no longer have a high temperature or feel unwell. These individuals are not required to take an LFD test if they are symptomatic.

If 2 or more linked care home residents develop symptoms of a respiratory infection within 14 days

This only applies to care homes.

During a suspected outbreak, there is no longer a need to test the whole home to identify COVID-19 cases.

Linked asymptomatic cases are no longer defined as outbreaks.

If 2 or more linked care home residents develop symptoms of a respiratory infection within 14 days of each other, the first 5 residents with symptoms should take a COVID-19 LFD test, whether or not they are eligible for COVID-19 treatments. After this, only residents who are eligible for COVID-19 treatments should take an LFD test if they become symptomatic.

If an outbreak is identified, care homes should revert to the guidance for management of single cases 5 days after the last positive or symptomatic case.

Further LFD testing in an outbreak should only be done following an HPT risk assessment and on HPT advice in relation to specific concerns.

Refer to the section on Outbreaks in care homes for further information.

Staff or service users with a positive COVID-19 test result

Individuals who test positive for COVID-19 should follow the guidance for people who have a positive COVID-19 test result.

Staff who have a positive COVID-19 test result

Staff who test positive should stay away from work for a minimum of 5 days after the day they took the test.

After 5 days, staff can return to work once they feel well, and do not have a high temperature. If they are still displaying respiratory symptoms when they return to work, they should speak to their line manager who should undertake a risk assessment.

Although many people will no longer be infectious to others after 5 days, some people may be infectious to other people for up to 10 days from the start of their infection. Staff should be supported to avoid contact with people at higher risk from becoming seriously unwell from COVID-19 for up to 10 days after the day they took their test.

Care home residents who have a positive COVID-19 test result

Care home residents who test positive should be supported to:

• stay away from others for a minimum of 5 days after the day they took the test
• access appropriate treatments as quickly as possible if they are eligible – refer to the section on Treatments for people at higher risk of severe outcomes
• receive at least one visitor at a time with appropriate IPC precautions; one visitor at a time per resident should always be able to visit inside the care home – this number can be flexible in the case that the visitor requires accompaniment (for example if they require support, or for a parent accompanying a child); this does not include visiting professionals – visitors should be advised before seeing a resident that they have had a positive test and are advised to stay away from others; this can be done by the resident or by the care home if they are not able to do this
• go into outdoor spaces within the care home grounds through a route where they are not in contact with other residents
• avoid contact with other people who are eligible for COVID-19 treatments for 10 days after a positive test

The care home manager should also inform the resident’s GP of the positive test result.

After 5 days, the resident can return to their normal activities if they feel well and no longer have a high temperature.

Residents who have tested positive for COVID-19 do not need to stay away from others for more than 10 days regardless of symptoms. Clinical advice should be sought as there may be other causes of continuing symptoms. Advice may be sought about period of staying away from others for residents who are eligible for and/or have taken COVID-19 treatments.

If an individual who is eligible for COVID-19 treatments remains unwell after 10 days, service providers should consider keeping this individual away from other residents beyond 10 days. This is because there is a risk that the individual remains infectious. Providers should seek clinical advice on this from a GP, and health protection advice from the HPT or other local partner.

Pulse oximeters will be available to care homes through their named clinical lead, or local ICB, as part of COVID-19 oximetry at home. One oximeter per 10 beds with a minimum of 2 oximeters per home is recommended. Equipment which is used to support the monitoring of residents will need to meet infection control and decontamination standards and guidance.

The Care Provider Alliance has produced guidance on COVID-19 oximetry for care home residents. Health Education England and West of England AHSN have also produced training and support for care home staff using pulse oximetry.

Care homes should have a weekly check-in with the home’s Primary Care Network (PCN) or multidisciplinary team, who can support staff to understand the RESTORE2 and NEWS2 scoring system as a way of monitoring residents with symptoms. If a patient’s symptoms worsen, it is important to contact NHS 111 or the registered GP for a clinical assessment either by phone or face to face.

The resident’s GP should give further advice on escalation and ensuring decisions are made in the context of the resident’s advance care plan. In a medical emergency, the care home should dial 999.

People receiving care outside of care homes who test positive

People receiving care who test positive for COVID-19 and do not live in a care home should follow the guidance for people with a positive test result.

If a person receiving care has tested because they are eligible for COVID-19 treatments, guidance on COVID-19 treatments should be followed to access appropriate treatments as quickly as possible.

Individuals who are contacts of confirmed COVID-19 cases

Individuals do not need to be tested if they have been in contact with a case of COVID-19.

Individuals who are household/overnight contacts should follow guidance for the general public set out in guidance for people with symptoms of a respiratory infection including COVID-19.

Outbreaks in care homes

Outbreak definition

An outbreak consists of 2 or more positive or clinically suspected linked cases of COVID-19, within the same setting within a 14-day period. This means the cases are linked to each other and transmission within the care setting is likely to have occurred.

An outbreak may be suspected when there is an increase in the number of residents displaying symptoms of a respiratory infection.

If an outbreak is suspected

The care home should undertake a risk assessment as soon as possible to determine if there is an outbreak and if control measures are needed. The provider should inform the HPT or other local partner of a suspected outbreak. However, they are not required to wait for advice from the HPT (or other relevant local partner) if they feel they are able to initiate the risk assessment independently.

The risk assessment can be undertaken directly by the care home provider using the expertise of relevant care home staff. Further support is also available from the local HPT (or other local partner according to local protocols) at the care home’s request.

To inform the risk assessment, the first 5 linked symptomatic residents should be tested using LFD tests irrespective of their eligibility for treatments. This is to determine if there are 2 or more linked cases of COVID-19 or another respiratory infection. After this, new cases do not require testing unless they are eligible for COVID-19 treatments, as set out above on when to test.

The risk assessment should determine if the cases are likely to have been the result of transmission within the care home, and if cases are therefore linked. In determining whether they are linked, the risk assessment should consider:

• whether there is a known source of infection
• whether there was contact between residents while one or more individuals had suspected or confirmed COVID-19
• whether the first identified case originated in the setting, for example, if the resident was in the setting up to 14 days prior to symptoms and/or a positive test

Cases would not be considered linked if:

• symptom onset was more than 14 days apart
• the residents had no contact with each other in the last 14 days

If residents are displaying symptoms of a respiratory infection and the LFD tests from the first 5 suspected cases are negative, consider:

• testing for other respiratory infections, such as flu
• further clinical assessment of the symptoms, if the residents remain unwell

The care home can contact the HPT or other relevant local partner for advice on further measures, which may include wider testing if there are specific issues of concern. These include but are not limited to:

• greater severity than expected.
• more deaths or hospitalisations than expected
• rapidly increasing cases despite control measures
• a suspected outbreak of another illness alongside COVID-19
• a high proportion of residents have been offered or accessed COVID-19 treatments during the outbreak

Providers should seek advice from the relevant local authority contact if there are staffing shortages or concerns about safety.

Wider outbreak testing should only be done if it is advised by the HPT or other local partner. The HPT may also provide advice if a variant of concern is suspected.

If an outbreak is identified

If the risk assessment determines that there are 2 or more linked positive cases of COVID-19 within the same setting within a 14-day period, additional measures to manage the outbreak should be considered, which may include:

• proportionate reductions in communal activities
• proportionate reductions in admissions which may include temporary closure of the home to further admissions
• restriction of movement of staff providing direct care to avoid risk of outbreaks spreading between different parts of settings (for example wings)
• proportionate changes to visiting. Some forms of visiting should continue for all residents. One visitor at a time per resident should always be able to visit inside the care home. This number can be flexible in the case that the visitor requires accompaniment (for example if they require support, or for a parent accompanying a child). End-of-life visiting should always be supported. There should be no restrictions on visits out for individuals who are not positive or symptomatic

Any measures that the care home chooses to implement must be proportionate, consider resident wellbeing, the care home’s legal obligations, and be risk-based. The care home manager should ensure staff, residents and their loved ones are informed of the outbreak and any relevant measures that have been implemented.

As noted above, where the local or national risk assessment indicates specific concerns, additional measures may be advised by the HPT or other local partner.

Outbreak measures can be lifted 5 days after the last suspected or confirmed case. This is from the day of the last positive test, or the day the last resident became unwell, whichever is latest.

Residents should be monitored for up to a further 5 days after this to ensure they can access appropriate treatments where necessary.

When COVID-19 testing is undertaken to identify whether COVID-19 is causing an outbreak (or when HPTs or other local partners advise additional testing), results should be reported even if negative or void. Managers can register multiple service user tests at once using the multiple upload spreadsheet.

In an outbreak scenario, care homes should use tests that have been ordered via the order portal for outbreak testing. Tests acquired through NHS local pharmacies may not have bar codes and therefore, may not be able to be registered.

Visiting arrangements in care homes

Access inside the care home and visits out

Contact with relatives and friends is fundamental to care home residents’ health and wellbeing and visiting should be supported. There should not normally be any restrictions to visits into or out of the care home. The right to private and family life is a human right protected in law (Article 8 of the European Convention on Human Rights).

It is important that any visitor follows the IPC processes put in place by the care home, such as practising hand hygiene and wearing appropriate personal protective equipment (PPE), as outlined in the section on PPE recommendations. Visitors should consider taking up any COVID-19 and flu vaccines they are eligible for.

Visitors should not enter the care home if they are feeling unwell, even if they have tested negative for COVID-19, are fully vaccinated and have received their booster. Transmissible viruses such as flu, respiratory syncytial virus (RSV) and norovirus can be just as dangerous to care home residents as COVID-19. If visitors have symptoms that suggest COVID-19, they should follow the guidance for people with symptoms of a respiratory infection.

In the event of an outbreak of COVID-19, each resident should (as a minimum) be able to have one visitor at a time inside the care home. This visitor does not need to be the same person throughout the outbreak. They do not need to be a family member and could be a volunteer or befriender. Additionally, end-of-life visiting should be supported in all circumstances.

Visits out should be facilitated wherever possible and there should not be any restrictions on visits out for individuals who are not symptomatic or who have not tested positive in any circumstance.

Care home residents should not usually be asked to avoid contact with others or to take a test following visits out of the care home.

Precautions for visitors

Care homes should ask visitors to follow the same PPE recommendations as care workers to ensure visits can happen safely. Additional requirements for face masks may be in place during a confirmed outbreak of COVID-19. This should be based on individual assessments, taking into account any distress caused to residents or barriers to communication from the use of PPE.

In the event that visitors are being asked to wear face masks, children under the age of 11 who are visiting may choose whether or not to wear a face mask. However, they should be encouraged to follow other IPC measures such as practising hand hygiene. Face masks for children under the age of 3 are not recommended.

Health, social care and other professionals may need to visit residents within care homes to provide services. Visiting professionals should follow the PPE recommendations as per other visitors.

Admission of care home residents

Hospital discharge

Individuals being discharged from hospital into a care home should be tested with a COVID-19 LFD test within 48 hours before planned discharge. This test should be provided and done by the hospital.

The result of the test should be shared with the individual and their key relatives or advocate. The relevant care should be provided within the hospital before the discharge takes place. Evidence of the LFD test result should be communicated by hospitals to care homes in writing within the usual communications provided at the time of discharging a patient to a care home.

Individuals who test positive for COVID-19 can be admitted to the care home if the home is satisfied they can be cared for safely. Individuals who are admitted with a positive test result should be kept away from other residents on arrival and should follow the guidance on care home residents who test positive for COVID-19.

The period individuals should stay away from others is from the day after the positive test and does not restart when the individual is admitted into the care home. If the individual has already tested positive before the planned discharge, they do not need to test again if they continue to have symptoms of a respiratory infection and feel unwell or have a high temperature.

Community admission

Individuals admitted from the community or other care settings do not need to be tested before they are admitted into the care home.

Personal protective equipment (PPE)

Appropriate PPE should be worn by care workers in all settings, as well as visitors to residential care settings, subject to a risk assessment. The advice below provides guidance on the type of PPE that is recommended.

For PPE to be effective, it is important to use it properly and follow instructions for putting it on (donning) and taking it off (doffing).

All used PPE should be disposed of appropriately according to the waste management section below.

Gloves, aprons and eye protection

Advice outlined here is in addition to recommendations for standard precautions (for example, when there is a risk of contact with blood or body fluids).

Gloves and aprons should be worn when the care worker or visitor is providing close care for a person who has suspected or confirmed COVID-19, or when cleaning their room. These should be removed and disposed of upon leaving the room or care recipient’s home.

Eye protection should be worn when providing close care to someone who has suspected or confirmed COVID-19, or when cleaning their room. Eye protection used in these circumstances should be removed after leaving the room, or home of the care recipient.

Reusable eye protection should be cleaned and disinfected as per the manufacturer’s instructions between use.

Face masks

Care workers and visitors to care homes do not routinely need to wear a face mask in care settings or when providing care in people’s own homes.

However, there are certain circumstances where it is recommended for staff and visitors to wear a face mask to minimise the risk of transmission of COVID-19. These are:

• if a person being cared for is known or suspected to have COVID-19 (staff and visitors are recommended to wear a Type IIR fluid-repellent surgical mask)
• if a COVID-19 outbreak has been identified within a care home
• if a care recipient would prefer care workers or visitors to wear a mask while providing them with care

Providers should also support the personal preferences of care workers and visitors who wish to wear a mask.

Type IIR masks should always be worn if there is a risk of splashing of blood or body fluids.

If a risk assessment has determined that masks should be worn, other mitigations should be considered if a person finds their use distressing or their use is impairing communication. This may be appropriate when caring for people with learning disabilities, cognitive conditions such as dementia, or supporting individuals who rely on lip reading or facial recognition.

It may be appropriate in certain circumstances to consider transparent face masks, some of which could be considered for use as an alternative to type IIR surgical masks. Transparent face mask technical specification offers further guidance.

All face masks should:

• be well fitted to cover the nose, mouth and chin
• be worn according to the manufacturer’s recommendations (check which side should be close to the wearer)
• not be allowed to dangle around the neck at any time, or rest on the forehead or under the chin
• not be touched once put on
• be worn according to the risk-assessed activity
• be removed and disposed of appropriately, with the wearer cleaning their hands before removal and after disposal

Face masks should be changed:

• if they become moist
• if they become damaged
• if they become uncomfortable to wear
• if they become contaminated or soiled
• at break times
• after providing care for someone with suspected or confirmed COVID-19
• between different people’s homes
• after 4 hours of continuous wear

Type IIR face masks

Type IIR fluid-repellent surgical masks protect the wearer by providing a fluid repellent barrier between the wearer and the environment. This protects the wearer against blood or body fluid splashes and against the respiratory droplets of others reaching their mouth and nose.

These masks also protect others from the wearer’s respiratory droplets. In addition to standard precautions, care workers should wear a Type IIR fluid-repellent surgical face mask when providing close care for people who are suspected or confirmed as having COVID-19, or when cleaning their rooms.

Type I and Type II face masks

Type I and Type II masks are not considered to meet the requirements of PPE. They are worn to provide source control, that is they protect others from the wearer’s respiratory droplets should they have asymptomatic COVID-19 infection. These masks can be worn when the use of masks at all times is recommended (such as during an outbreak).

These masks are not fluid repellent and therefore should not be worn for activities where there is a risk of splash of blood, body fluids or hazardous cleaning products, or when caring for an individual with suspected or confirmed COVID-19.

Use of face masks for care ‘sessions’

Sessional use of masks only applies when working in a communal setting, for example a care home, and caring for a cohort of clients who are all suspected or confirmed to have COVID-19, or if the use of masks at all times is recommended, such as during an outbreak.

After 4 hours, or after leaving the room (or cohorted area) of someone with suspected or confirmed COVID-19 (whichever is sooner) masks should be disposed of and hand hygiene performed before putting on a new mask (if required).

Aerosol-generating procedures (AGP)

An aerosol generating procedure (AGP) is a medical procedure that can cause the release of virus particles from the respiratory tract and can increase the risk of airborne transmission to those in the immediate area. AGPs in the community setting include tracheostomy procedures (insertion or removal) and open suctioning beyond the oro-pharynx.

Filtering face piece class 3 (FFP3) respirators are required when undertaking an AGP on a person with suspected or confirmed COVID-19 infection, or another infection spread by the airborne or droplet route. FFP3 respirators should be removed and disposed of outside of the room where the AGP was carried out.

The use of FFP3s is governed by health and safety regulations and they should be fit tested to the user to ensure the required protection is provided. The Health and Safety Executive (HSE) provides information and tools to help select and manage the use of respiratory protective equipment (RPE).

Workers should wear a Type IIR mask when carrying out an AGP on someone who is not suspected or confirmed to have COVID-19 or another infection spread via airborne or droplet routes.

FFP3 respirators or face masks should be removed and disposed of when leaving the house if undertaking an AGP in someone’s own home.

Workers should wear gloves, aprons and eye protection when carrying out AGPs. Where there is an extensive risk of splashing, workers should wear fluid repellent gowns instead of aprons.

Following an evidence review commissioned by NHS England and Improvement, the list of procedures which are currently classed as AGPs in relation to respiratory infections and are most likely to be relevant to adult social care are:

• awake bronchoscopy (including awake tracheal intubation)
• awake ear, nose, and throat (ENT) airway procedures that involve respiratory suctioning
• awake upper gastro-intestinal endoscopy
• dental procedures (using high-speed or high-frequency devices, for example ultrasonic scalers or high-speed drills)
• induction of sputum
• respiratory tract suctioning
• tracheostomy procedures (insertion or removal)

‘Awake’ includes conscious sedation (excluding people who are anaesthetised with secured airway).

The available evidence relating to respiratory tract suctioning is based on individuals who are ventilated. In line with a precautionary approach, open suctioning of the respiratory tract regardless of association with ventilation has been incorporated into the current COVID-19 AGP list. Open suctioning beyond the oro-pharynx is currently considered an AGP – that is, oral or pharyngeal suctioning is not an AGP.

Certain other procedures or equipment may generate an aerosol from material other than patient secretions but are not considered to represent a significant infectious risk for COVID-19. In care settings, procedures commonly undertaken which are not classified as AGPs include:

• non-invasive ventilation (NIV)
• bi-level positive airway pressure ventilation (BiPAP) and continuous positive airway pressure ventilation (CPAP)
• high flow nasal oxygen (HFNO)
• oral or pharyngeal suctioning (suctioning to clear mucus or saliva from the mouth)
• administration of humidified oxygen
• administration of Entonox or medication via nebulisation

PPE recommendations summary

The tables below detail some common scenarios in care and the appropriate PPE to be worn.

In circumstances where the use of masks at all times is in place, follow the recommendations for mask use in the tables and in addition wear a Type I, II or IIR surgical mask for activities where the use of a mask is not normally recommended. See section on Use of face masks for care ‘sessions’ for guidance on sessional use of masks.

Table 1: PPE requirements when caring for a person not known or suspected to have COVID-19

See Table 3 for aerosol generating procedures.

Activity	Face mask	Eye protection	Gloves	Apron
Social contact with clients, staff, visitors	No	No	No	No
Care or domestic task involving likely contact with blood or body fluids (giving personal care, handling soiled laundry, emptying a catheter or commode)	Risk assess – Type IIR if splashing likely	Risk assess if splashing likely	Yes	Yes
Tasks not involving contact with blood or body fluids (moving clean linen, tidying, giving medication, writing in care notes)	No	No	No	No
General cleaning with hazardous products (disinfectants or detergents)	Risk assess – Type IIR if splashing likely or if recommended by manufacturer of cleaning product	Risk assess or if recommended by manufacturer of cleaning product	Risk assess or if recommended by manufacturer of cleaning product	Risk assess or if recommended by manufacturer of cleaning product

For the scenarios in Table 1, change PPE between tasks and between caring for different care recipients. Hand hygiene should be carried out before putting on and after removing PPE.

For people with an infectious illness other than COVID-19, follow the above principles and any additional advice for the specific infection.

Note: sessional use of masks applies to communal care settings only.

Table 2: PPE requirements when caring for a person with suspected or confirmed COVID-19

See Table 3 for aerosol generating procedures.

Activity	Face mask	Eye protection	Gloves	Apron
Giving personal care to a person with suspected or confirmed COVID-19	Yes – Type IIR	Yes	Yes	Yes
General cleaning duties in the room where a person with suspected or confirmed COVID-19 is being kept away from others or cohorted (even if more than 2 metres away)	Yes – Type IIR	Yes	Yes	Yes
For tasks other than those listed above, when within 2 metres of a person with confirmed or suspected COVID-19	Yes – Type IIR	Yes	Risk assess (if contact with blood or body fluids likely)	Risk assess (if contact with blood or body fluids likely)

Masks and eye protection used while providing care for people with suspected or confirmed COVID-19, as listed in Table 2, should be removed on leaving the room or cohort area. Gloves and aprons may need to be changed between tasks, as per standard precautions, and should always be removed on leaving the room or cohort area. Hand hygiene should be carried out before putting on and after removing PPE.

Table 3: PPE requirements when undertaking AGPs

Activity	Face mask	Eye protection	Gloves	Apron
Undertaking an AGP on a person who is not suspected or confirmed to have COVID-19 or another infection spread by the airborne or droplet route	Yes – Type IIR to be used for single task only	Yes	Yes	Yes (consider a fluid repellent gown if risk of extensive splashing)
Undertaking an AGP on a person who is suspected or confirmed to have COVID-19 or another infection spread by the airborne or droplet route	Yes – FFP3 RPE to be used for single task only	Yes – goggles or a visor should always be worn If there is a risk of contact with splash from blood or body fluids and the FFP3 is not fluid resistant this needs to be a full-face visor (which covers the eyes, nose and mouth area)	Yes	Yes (consider a fluid repellent gown if risk of extensive splashing)

The PPE listed in Table 3 should be removed on leaving the room where the AGP was undertaken and before undertaking any other tasks or caring for any other care recipients. Hand hygiene should be carried out before putting on and after removing PPE.

Environmental IPC recommendations

This guidance should be read alongside the Infection prevention and control: resource for adult social care guidance, which contains best practice for general IPC measures.

Ventilation

Ventilation is an important IPC measure. Letting fresh air from outdoors into indoor spaces can help remove air that contains virus particles and prevent the spread of COVID-19.

Rooms should be ventilated whenever possible with fresh air from outdoors after any visit from someone outside the setting, or if anyone in the care setting has suspected or confirmed COVID-19.

The comfort and wishes of the person receiving care should be considered in all circumstances, for example balancing with the need to keep people warm. Rooms may be able to be repurposed to maximise the use of well-ventilated spaces, which are particularly important for communal activities.

Further information regarding ventilation can be found in Infection prevention and control: resource for adult social care and guidance on the ventilation of indoor spaces.

Waste management

In addition to standard precautions the following should be observed:

• in a nursing care home, waste generated when supporting a person with confirmed COVID-19 should enter the hazardous waste stream (usually an orange bag). Other care homes may have a hazardous waste stream and should use it if available
• waste visibly contaminated with respiratory secretions (sputum, mucus) from a person suspected or confirmed to have COVID-19 should be disposed of into foot-operated lidded bins lined with a disposable waste bag
• if there is not access to a hazardous waste stream, such as waste generated in people’s own homes, this should be sealed in a bin liner before disposal in the usual way

Ordering tests

How to access tests for outbreak testing in a care home

Care homes regulated by the Care Quality Commission (CQC) can access COVID-19 LFD tests to identify whether COVID-19 is causing an outbreak.

Care homes can place an order online for free COVID-19 LFD tests to be used in the event of a suspected outbreak using their Unique Organisation Number (UON). Enough tests should be ordered to test up to 5 (or more, if requested by the HPT) residents with symptoms to identify if COVID-19 is causing an outbreak.

Care homes should check to ensure they have sufficient stocks of tests for outbreak testing that are in date.

How to access tests for people eligible for COVID-19 treatments in a residential care setting

Care providers can access tests on behalf of service users who are eligible for COVID-19 treatments and therefore eligible for symptomatic testing.

Tests for this purpose are supplied by the NHS and should be accessed from a local pharmacy. Providers should speak to their usual pharmacy (for example those that provide residents’ medicines) or other pharmacies to discuss access arrangements and whether the pharmacy is able to deliver tests in addition to collection options.

Pharmacies may ask questions about an individual’s medical history to confirm eligibility for free LFD tests and update patient records for future tests orders.

Providers accessing tests on behalf of their service users should provide the pharmacy with the details of eligible individuals where required, including any relevant letters or emails about COVID-19 treatments, if these are available. The required details include:

• medical condition(s) that indicate the service user is eligible
• the service user’s NHS number (if available)
• the service user’s full name
• the service user’s date of birth
• the address of the setting

Providers should ensure that there are at least 3 tests available per eligible individual to enable them to test for 3 consecutive days if they develop COVID-19 symptoms. 

More details from the NHS about this service can be viewed on the NHS page on the LFD tests supply service, and further information is available on ordering tests for those who are eligible for COVID-19 treatments.

A provider’s usual pharmacy may be able to provide details on which other local pharmacies are offering this service if they do not hold stock. It is important to plan ahead and make sure there are always sufficient LFD test kits in the home in advance. For further questions about COVID-19 treatments, refer to the local ICB website.

How to access tests for people eligible for COVID-19 treatments who do not live in a residential care setting

People receiving social care who do not live in a care home and are eligible for COVID-19 treatments can access free COVID-19 tests via the NHS. They should be supported to do so where necessary. More information is available at NHS guidance on COVID-19 treatments.

How to register a test result

When COVID-19 testing is undertaken to identify whether COVID-19 is causing an outbreak (or when HPTs or other local partners advise additional testing), results should be reported even if negative or void. Managers can register multiple service user tests at once using the multiple upload spreadsheet.

In an outbreak scenario, care homes should use LFD tests that have been ordered via the order portal for outbreak testing. Tests acquired through NHS local pharmacies may not have bar codes and therefore may not be able to be registered.