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Introduction

This guidance is to help care home providers, Local Health Boards, local authorities and others interpret and implement testing policy for care homes in Wales. Its main purpose is to clarify how we can reduce the risk of transmission of Covid-19 in residential care home settings. It does not cover testing people being discharged from hospital to live in care homes (regardless of whether they were admitted to hospital with Covid-19) or people being transferred between care homes or for new admissions from the community.

The safety and protection of the most vulnerable people in our communities is central to the Welsh Government’s response to Covid-19. People living in care homes and other similar residential settings will be amongst the most vulnerable, with many relying on close personal care. Large scale testing in care homes is vital to prevent and manage outbreaks. It is important that this testing is carried out quickly.

Asymptomatic testing of care home staff

As part of a package of measures for managing Covid-19 in care homes in Wales and protecting residents and staff, we introduced a programme of asymptomatic testing of staff on 15 June 2020. Taking account of the data and feedback from the care home sector, Local Health Boards, local authorities and trade unions, we have extended the programme until the end of December 2020 enabling statutory partners to determine whether staff in care homes in their local areas should be tested either weekly or fortnightly using their professional judgement informed by data on the incidence and transmission of Covid-19 in their local communities and local intelligence.

All asymptomatic testing of care home staff should now be undertaken through the UK Organisations Portal and the Lighthouse laboratories.

The policy to re-test individuals who receive a positive result through asymptomatic testing will remain a Welsh Government decision.

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

The first priority is the rapid response to a care home that reports its first symptomatic case in a resident or staff member. Early tests of all residents and staff in newly identified outbreaks is likely to reduce the risk of Covid-19 spreading. The care home should notify and seek advice from Public Health Wales by phoning 0300 003 0032. The care home should request testing from the Local Health Board.

Local Health Board contact details for care homes

Aneurin Bevan University Health Board
COVID-19.Testing.Unit.ABB@wales.nhs.uk 

Betsi Cadwaladr University Health Board
BCU.Covid19CareHomeTestingHub@wales.nhs.uk  

Cardiff and the Vale University Health Board
cardiffandvalecommunicationhub@wales.nhs.uk

Cwm Taf Morgannwg University Health Board
ctm_covid19@wales.nhs.uk or 01656 752993

Hywel Dda University Health Board
COVIDenquiries.hdd@wales.nhs.uk or 0300 303 8322

Swansea Bay University Health Board
Sbu.neathpch@wales.nhs.uk or 01639 862757 open 09:00 to 20:00

Powys Teaching Health Board
pthbcovid19@wales.nhs.uk

The expectation is that a Local Health Board, when it receives a request to test suspected or symptomatic Covid-19 cases, will arrange for residents to be tested within 24 hours and staff to be tested within 48 hours. If Covid-19 is confirmed, the Health Board will arrange for all residents and staff to be tested and provide the full results to Public Health Wales. Isolating and mass testing of consented staff and residents within 24 hours of the report of the outbreak is important. If an outbreak is identified early more testing should be offered to residents and staff who initially tested negative after one week. Should more possible cases present, the Health Board should arrange for confirmatory testing.

The Health Board is responsible for confirming the test results of all residents and staff, both positive and negative. Results should be made available within 48 hours. Large scale testing will have implications for care home providers. They will need to plan in advance with local partners for the possibility that many residents will need to isolate and many staff members will need to self-isolate at home.

Testing all residents and staff in established care home outbreaks

There is plenty of evidence that shows 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 where there is an outbreak will have less benefit in reducing the spread of the virus, it does have some benefit. Testing should be offered to those residents and staff who have never tested positive for Covid-19. This testing may identify Covid-19 positive asymptomatic (people who are not showing symptoms) residents and staff. If there are no further cases  it will provide reassurance that the strict infection prevention and control measures, such as the use of PPE, are working 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. In an established outbreak many staff showing symptoms 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.

Managing residents and staff who test positive for Covid-19

Testing in care homes with Covid-19 has shown that asymptomatic (people who are not showing symptoms) residents and staff may test positive for Covid-19. Many of these will go on to develop symptoms. There is evidence that the spread of the virus can happen before people develop symptoms, and in people 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 have to provide a daily situation report on testing in care homes to Care Inspectorate Wales and Public Health Wales. This situation report includes:

  • 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.