COVID-19: outbreaks in higher-risk communal accommodation settings
This guidance provides information on COVID-19 in homelessness, domestic abuse refuge, respite room and asylum seeker accommodation settings.
Main messages
This guidance provides information on COVID-19 in homelessness, domestic abuse refuge, respite room and asylum seeker accommodation settings.
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 that:
- symptomatic staff, residents and service users should not be tested, except those eligible for COVID-19 treatments, or if short term symptomatic testing is recommended as part of a health protection team (HPT) led outbreak response
- COVID-19 should be managed like other respiratory infections
- multiplex polymerase chain reaction (PCR) testing should be conducted in up to 5 linked symptomatic cases with most recent symptom onset in a suspected outbreak of acute respiratory infection (ARI) to identify positive individuals
What has changed
This guidance has been updated in line with changes to testing policy from 1 April 2024. The ordering portal for accessing lateral flow device (LFD) test kits for outbreak testing has now closed. During a suspected outbreak of ARI, settings can access multiplex PCR tests through their local health protection team (HPT) to help identify the infection responsible.
Who this guidance is for
This guidance is for commissioners, providers and staff in the following settings and services in England:
- asylum seeker accommodation settings, for example contingency or initial accommodation centres
- bridging accommodation (for example, temporary hotel accommodation for individuals being resettled to the UK)
- homeless accommodation settings (for example, hostels and night shelters)
- domestic abuse refuges
- respite rooms
- Ministry of Defence healthcare settings or settings being used to house individuals for emergency or temporary accommodation
These settings will be referred to in this guidance as ‘inclusion health settings’.
Additional guidance on outbreak management in short term asylum seeker accommodation settings and broader public health guidance on operating night shelters is also available.
This guidance does not apply to adult social care, prisons and places of detention (PPDs), secure children’s homes, secure schools, secure training centres and Young Offenders Institution units for those aged under 18 years. For these settings, guidance on the management of COVID-19 and other acute respiratory infections is available for:
Background
As a result of high levels of population immunity, the availability of COVID-19 vaccines and treatments, and reduced severity of illness, we are now able to manage COVID-19 like other respiratory infections.
In line with this approach, testing and infection prevention and control (IPC) measures in this guidance are focused on reducing severe outcomes in individuals who are at a higher risk from COVID-19 and who are eligible for treatments.
Inclusion health settings are considered higher risk for transmission of COVID-19 and poor outcomes for the following reasons:
- there is a higher risk of COVID-19 transmission due to crowding, people sharing rooms, shared facilities, staff turnover and less adequate ventilation
- individuals within these settings may be at higher risk of severe illness from COVID-19 due to poorer health and/or lower vaccination coverage
- individuals in these settings may be less able to isolate or take other actions to prevent the spread of COVID-19
As a result, outbreaks in these settings may have a greater impact than in other settings.
Definitions
Outbreak of COVID-19
An outbreak of COVID-19 is defined as 2 or more linked cases of COVID-19 within 5 days.
As most symptomatic COVID-19 testing has been removed, an outbreak may be suspected when there is an increase in the number of staff and/or detainees displaying symptoms of ARI at the same time who are linked by personal contact.
Acute respiratory illness
Acute respiratory illness is defined as the acute onset of one or more specific respiratory symptoms and a clinician’s judgement that the illness is due to a viral ARI (for example COVID-19, flu, respiratory syncytial virus (RSV)).
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:
(i) oral or ear temperature ≥37.8C
and
(ii) one of the following:
- 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
or
- an acute deterioration in physical or mental ability without other known cause
Symptoms of acute respiratory illness, including COVID-19: management of staff and service users
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, your 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
Individual testing for COVID-19 in inclusion health settings is now only offered to people experiencing symptoms of a respiratory infection who are eligible for COVID-19 treatment.
Staff and service users with symptoms of respiratory infection should be supported to follow guidance for people with symptoms of a respiratory infection, including COVID-19.
If staff, volunteers or service users have symptoms of a respiratory infection, such as COVID-19, and have a high temperature or do not feel well enough to go to work or carry out normal activities, they should be encouraged to stay at home or in their room and avoid contact with other people. If possible, service users with symptoms of a respiratory infection should be provided with single room accommodation. They can return to work or usual activities when they no longer have a high temperature (if they had one) or when they no longer feel unwell.
It is particularly important they try to avoid close contact with anyone known to be at higher risk of becoming seriously unwell if they are infected with COVID-19 and other respiratory infections, especially those whose immune system means that they are at higher risk of serious illness, despite vaccination.
If staff or service users are unable to avoid contact with other people while they have symptoms of a respiratory infection, 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
- avoiding crowded places such as public transport, large social gatherings, or communal places, or anywhere that is enclosed or poorly ventilated
- taking any exercise outdoors in places where they will not have close contact with other people
- covering the 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; avoid touching their face
More information on how to limit the spread of COVID-19 in these settings is available.
Healthcare staff employed by the NHS or other healthcare providers should follow guidance on managing healthcare staff with symptoms of a respiratory infection, including COVID-19.
Service users eligible for COVID-19 treatments
Staff in the respective settings should identify service users who are eligible for COVID-19 treatments and ensure they can access COVID-19 testing if required. COVID-19 and other ARIs have similar symptoms.
If a resident or service user is experiencing COVID-19 symptoms (even if they are mild) and is eligible for COVID-19 treatments, they should take an LFD test immediately. If the result is positive the healthcare service should follow the guidance on COVID-19 treatments.
If the test result is positive, they should also follow the guidance on if a person tests positive for COVID-19, found below.
If the individual’s LFD test results are all negative, they can return to their usual activities once they are well enough to do so, and they do not have a high temperature.
Staff in other high-risk inclusion health residential settings should:
- make sure those who are eligible for treatment are registered with a GP
- confirm that the contact details for those eligible are up to date, and they or a representative are contactable
Staff and volunteers eligible for COVID-19 treatments
If a staff member is experiencing COVID-19 symptoms and is eligible for COVID-19 treatments they should follow NHS guidance on treatment for COVID-19.
Positive COVID-19 test result: managing staff and service users
Routine COVID-19 testing is not required for symptomatic staff or service users who are not eligible for treatments.
Staff and service users with a positive COVID-19 test result should be supported to follow guidance for people with symptoms of a respiratory infection, including COVID-19. Most people with COVID-19 will no longer be infectious to others after 5 days.
Staff and service users with a positive COVID-19 test result should be supported to stay away from other people 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.
Where possible, service users with a positive COVID-19 test should be supported to isolate in single occupancy accommodation.
If a person who has tested positive for COVID-19 remains unwell after 10 days or longer, they should seek medical advice.
Service users who are isolating away from others should have regular opportunities to discuss their wellbeing and any anxieties with a member of staff or key workers.
More information on how to limit the spread of COVID-19 in these settings is available.
Healthcare staff employed by the NHS or other healthcare providers should follow guidance on managing healthcare staff with symptoms of a respiratory infection, including COVID-19.
Isolation
All high-risk inclusion health residential settings should have a plan in place to identify appropriate facilities where service users who have been tested positive for COVID-19 or another respiratory infection can be supported to self-isolate appropriately.
If single occupancy accommodation is not available, confirmed cases may be cohorted (grouped and isolated) together.
Testing to end isolation is no longer required for confirmed COVID-19 cases.
Seeking further clinical input
If the health condition of a service user is worsening, settings are advised to seek clinical advice.
If a service user is deteriorating despite a negative COVID-19 test, and they have not been tested for other causes as part of outbreak testing, other causes should be considered by clinicians, including testing for ARIs.
Management of contacts of confirmed COVID-19 cases
There is no need for contacts of a confirmed COVID-19 case to undertake testing. This applies to staff and service users.
Contacts should be supported to:
- minimise contact with the person with confirmed COVID-19
- avoid contact with anyone whose immune system means they are at higher risk of serious illness, despite vaccination
- follow relevant guidance if they develop symptoms of COVID-19
Routine contact tracing is not currently being undertaken in inclusion health settings.
COVID-19 outbreak management
An outbreak is defined as 2 or more linked cases of COVID-19 within 5 days.
As most symptomatic COVID-19 testing has been removed, an outbreak may be suspected when there is an increase in the number of staff and/or service users displaying symptoms of COVID-19 at the same time who are linked by personal contact.
Contacting the local health protection team
If an outbreak is suspected, staff should undertake a risk assessment as soon as possible to determine whether the local HPT should be contacted.
The setting provider should contact the HPT if there are specific issues of concern. For example, if:
- there are a high number of hospitalisations or unexpected deaths among service users
- there is a rapid increase in the number of service users with symptoms of COVID-19 or other respiratory infections
- there is a suspected outbreak of another infection in addition to COVID-19
Testing during 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, contact your local HPT who will conduct a risk assessment. 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 individuals who are 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.
Outbreak measures
Following initial risk assessment by the HPT with the setting, HPTs may convene an Outbreak Control Team (OCT) to support management and help coordinate the outbreak response.
The OCT will make recommendations on:
- infection prevention and control
- outbreak control measures
- any additional testing
- contact tracing
- any additional information required to inform decisions and effective control measures
- antiviral use (only applicable for flu)
- communications (to service users, staff, visitors, local stakeholders and media)
After a risk assessment, and subject to discussion with the service managers, further temporary outbreak control measures that may be considered by OCTs include:
- reinstating contact tracing
- proportionate reduction in communal activities
- cohorting of service users suspected or confirmed to have COVID-19 into similar groups to help manage risk
- reintroduction of social distancing
- introduction of enhanced IPC and personal protective equipment (PPE) measures being used in the setting, including the use of face coverings
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 personal protective equipment (PPE) and social distancing can be maintained for longer than 10 days if required.
Limiting the spread of acute respiratory infections, including COVID-19
There are actions that settings can take to limit the spread of respiratory infections, including COVID-19. Operational practices may vary due to setting-specific considerations.
Vaccination
All eligible service users and staff are strongly encouraged to be vaccinated to protect themselves and others from COVID-19. This is especially important given the vulnerabilities of people in high-risk inclusion health settings. Booster vaccinations are strongly recommended for individuals if they are eligible.
Information on the COVID-19 vaccination programme is available in the Green Book, chapter 14a (page 29 onwards), with further resources on the COVID-19 vaccination programme also available.
Ventilation
Bringing in fresh air to occupied spaces can help to reduce the concentration of respiratory particles, lowering the risk of airborne transmission of respiratory viruses.
Other mitigation measures should be determined by risk assessment and implemented appropriately.
Personal protective equipment
During an outbreak, staff use of fluid resistant surgical masks (Type IIR) should be considered to reduce transmission of COVID-19, particularly in poorly ventilated or crowded areas. This is known as source control and prevents spread from the wearer to others. This should also be considered when caring for a person who is at higher risk of becoming severely unwell if they are infected with COVID-19.
Principles of cleaning
Regular cleaning can help reduce the risk of spreading infection.
Standard cleaning products such as detergents are adequate to clean routinely.
Respiratory infections such as flu and COVID-19 can be spread from person to person through small droplets, aerosols and through direct contact. Surfaces and belongings can also be contaminated when people with infections cough or sneeze or touch them.
When a person is known or suspected to have an infection, 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.
Cleaning and disinfection of frequently touched surfaces is particularly important in bathrooms and communal kitchens.
As a minimum, frequently touched surfaces such as door handles, light switches, work surfaces, remote controls and electronic devices should be cleaned daily. Cleaning should be more frequent depending on the number of people using the space, whether they are entering and exiting the setting and access to handwashing and hand-sanitising facilities.
Suitable hand washing facilities should be available including running water, liquid soap and paper towels or hand driers. Hands should be cleaned after removing PPE or handling contaminated surfaces or laundry.
Waste
Waste visibly contaminated with respiratory secretions from a person with suspected or confirmed infection should be sealed in a waste bag before removal from the accommodation 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.
Laundry
Wash items in accordance with the manufacturer’s instructions. Use the warmest water setting and dry items completely. If water-soluble (alginate) bags are available, use this to transport laundry from the unwell individual’s accommodation to the washing machine.
Used laundry that has been in contact with an unwell person can be washed with other people’s items. To minimise the possibility of dispersing virus through the air, do not shake used laundry prior to washing.
Visitors or volunteers
Visitors or volunteers should follow the guidance for people with symptoms of a respiratory infection including COVID-19 if they experience symptoms.
Visitors or volunteers that are a confirmed case of COVID-19 should try to stay at home and not participate in visits. They can participate in visits or volunteering again once their symptoms have resolved, and they have satisfied the criteria for starting to participate in normal activities, either for people with symptoms or people with a positive test result.
How to access COVID-19 test kits
Service providers should support service users to access test kits for those eligible for COVID-19 treatments. These can be accessed from the NHS.
Reporting test results
Under Regulation 4A of The Health Protection (Notification) Regulations 2010, higher risk settings are still required to report positive, negative and void LFD test results where they have assisted residents to take an LFD.
To support settings in being able to meet their Regulation 4A duty, the UKHSA multiple registration spreadsheet will remain available for settings to report COVID-19 LFD test results. Settings are still able to use this route to report the result of LFD tests that have not been provided to the setting directly by UKHSA.
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 support service users to access COVID-19 treatments, follow the guidance issued by the NHS.
Last updated 25 March 2024 + show all updates
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Updated in line with changes to outbreak testing from 1 April 2024.
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Updated information on termination of testing services.
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First published.