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Introduction

This interim guidance is to aid health boards, care home providers for adults and children, local authorities, and others to interpret and implement the extended testing policy for care homes in Wales. The main purpose of this health protection guidance is to clarify what is required to achieve the greatest potential reduction in the risk of transmission of the virus in residential care home settings, in the shortest possible time. The guidance will also help health boards and care homes manage Covid-19 PCR positive asymptomatic staff. The guidance is interim as it may change as new evidence emerges.

This interim guidance does not cover the testing of people being discharged from hospital to live in care homes (regardless of whether or not they were admitted to hospital with Covid-19) or people being transferred between care homes or for new admissions from the community. Read the guidance for these scenarios.

The safety and protection of the most vulnerable people in our communities is central to the Welsh Government’s response to the Covid-19 pandemic. People living in care homes and other similar residential settings will be amongst the most vulnerable, with many relying on close personal care. The large scale implementation of testing in care homes is vital to prevent and manage outbreaks. It is important that this testing is done at pace, utilising all available testing capability, before further easing of lockdown response.

Care home testing policy

From Monday 10 August all care home staff will be offered a fortnightly test for an eight week period. If there are higher prevalence rates in some areas of Wales then the frequency of the testing will be increased.

Testing all residents and staff members of care homes reporting a possible case of Covid-19 in a resident or member of staff in a previously unaffected home or a care home that had no possible or confirmed case in the previous 28 days

The first priority remains the rapid response to a care home that reports its first symptomatic case in a resident or staff member. Early intervention to test all residents and staff in newly identified outbreaks is likely to have the greatest potential in terms of reducing the risk of ongoing viral transmission most quickly.

All health boards, care home providers and local authorities received communication from the Chief Medical Officer and the Deputy Director General, Health and Social Services Group, on 13 May requesting that this outbreak response be implemented with immediate effect. The care home should notify and seek advice from Public Health Wales by phoning: 0300 00 300 32. The care home should request testing from the health board. Health board contact numbers are included in the testing infographic.

The expectation is that a health board, on receiving a request for testing of a possible case of Covid-19, will arrange for testing of the resident within 24 hours and the staff member within 48 hours. Should Covid-19 be confirmed, the health board will arrange for testing of all residents and staff and provide the full results to Public Health Wales to aid outbreak management. The isolation and first mass testing of consented staff and residents will be most beneficial if it occurs within 24 hours of the report of the outbreak. If an outbreak is identified early further testing should be offered to residents and staff who initially tested negative after one week. Should further possible cases present, the health board will arrange for confirmatory testing.

The health board is responsible for communicating all residents’ test results, both positive and negative, to the care home and for communicating positive and negative results to care home staff. Results should be available within 48 hours. Such large scale testing will have implications for care home providers who will need to plan in advance with local partners for the possibility of many residents requiring isolation and many staff members in self-isolation at home.

Testing all residents and staff in established care home outbreaks

There is plenty of available evidence that demonstrates the speed with which Covid-19, as with other respiratory viruses, spreads in care homes. While testing all residents and staff in a care home with an established outbreak will have less benefit in reducing transmission it does have benefit. Testing should be offered to those residents and staff who have never tested positive for Covid-19. This testing offer may identify Covid-19 positive asymptomatic residents and staff. If no further cases are identified it will provide reassurance that the strict infection prevention and control measures, including appropriate use of PPE, implemented are effective and provide reassurance to staff, residents, and their families.

The testing delivery model for an established outbreak is the same as that for new outbreaks.

As this is an established outbreak many symptomatic staff may already have self-isolated for 10 days and returned to work while others may still be self-isolating. Providers will need to plan in advance with local partners for the possibility of  more staff members in self-isolation at home.

Testing residents and staff in care homes who have never reported possible or confirmed cases of Covid-19 in residents or staff or have had no cases in last 28 days

There is evidence that testing all residents and staff in a care home unaffected by Covid-19 will identify a small number of individuals testing positive for Covid-19. There is benefit in identifying early introduction of Covid-19 into the home as prompt outbreak control measures can be put in place.

Such large scale testing will have implications for care home providers who will need to plan in advance with local partners for the possibility of some residents  requiring isolation and some staff members in self-isolation at home.

Care homes may have the testing of staff and residents delivered by 1 of 2 routes, either directly by the health board or by the Social Care Portal. This Portal which goes live shortly has a daily testing capacity and to ensure care homes in Wales are tested in a timely fashion it will run parallel to NHS testing. Care homes will be notified in advance of which testing method will apply to them. For either delivery model the largest care homes will be targeted first as evidence shows that they were the mostly severely impacted by Covid-19 outbreaks.

Management of residents and staff who test positive for Covid-19

Testing in care homes with Covid-19 has shown that asymptomatic residents and staff can test positive for Covid-19. Many of these will go on to develop classic symptoms. There is growing evidence that spread of the virus can occur before cases develop symptoms and in those who may never develop symptoms. All Covid-19 positive residents and staff should be isolated as per the Public Health Wales guidance irrespective of whether or not they have symptoms.

Reporting to Public Health Wales and Care Inspectorate Wales

Health Boards are requested to provide a daily situation report on testing in care homes to Care Inspectorate Wales and Public Health Wales. This situation report  needs to include:

  • name of home
  • reason for testing: new outbreak, ongoing outbreak, opportunistic testing in an unaffected home
  • for each home the number of residents and staff tested
  • the situation report to be updated when tests results are known (number of positive Covid-19 cases in residents and staff)

This should be e-mailed to CIWInformation@gov.wales and copied to phw.covid19enclosedsettings@wales.nhs.uk

It should be backdated to capture data on care homes where testing of all residents and staff has taken place.

To facilitate the situation reporting, Care Inspectorate Wales has established a prepopulated file for health boards to complete and return daily.

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