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Overview

This guidance, for health and social care staff who are contacts of someone who has tested positive for COVID-19, it outlines a process of local risk assessment and mitigations for employers to apply accordingly.

This guidance has been updated to reflect changes to self-isolation legislation from March 28th 2022.

The majority of health and social care staff will be able to continue with their usual duties and should use lateral flow tests (LFT) for regular asymptomatic testing.  

We will keep this guidance under review to ensure additional measures remain justified and are proportionate to the current risk.

Infection prevention and control

To support the mitigation of risks, workers must continue to adhere to their employer’s guidance on infection prevention and control measures. This includes social distancing in the workplace when not delivering care or treatment and the use of PPE in line with the current Public Health Wales/UK COVID-19 IPC guidance COVID-19: infection prevention and control (IPC (gov.uk).

Who does this guidance apply to?

Anyone working in a health or social care role AND who is in close contact with patients or service users:

  • who is a contact of someone who has tested positive and
  • does not have the main symptoms of COVID-19

Workers who have been identified as a contact of someone who has tested positive and who work in close contact with patients/service users

Where the staff member is providing care, support or treatment, which means they are unable to maintain a social distance. This may include:

  • the administration of medical treatment
  • provision of personal care
  • supporting the individual to promote their independence
  • other interventions bringing staff into close contact with the patient/service user

Staff must agree to the specified testing process to continue to work with patients/service users. 

If they do not agree they should be redeployed or not attend work for 7 days. 

Workers in close contact with patients/service users who are known to be immunosuppressed and/or clinically extremely vulnerable

Staff should ordinarily not continue to work with these patients/service users when identified as a contact of a COVID-19 positive case. 

Staff should be redeployed to work with patients/service users who are known to not be immunosuppressed and/or clinically extremely vulnerable for at least 7 days. 

They will be asked to take the necessary tests or asked not to attend work.

If neither of the scenarios above apply

There are no specific requirements arising from this guidance on these workers. 

These workers should:

  • remain vigilant for symptoms and self-isolate and take a PCR test if symptoms develop. 
  • continue to follow Welsh Government advice and regularly use lateral flow tests in line with the advice

What are the risks to be balanced?

Direct harms caused to people infected with COVID-19 i.e negative medical outcomes must be balanced alongside the non-direct COVID harms such as maintaining the workforce required to care for vulnerable patients and service users and maintain critical services.   

The evidence shows us: 

  • Those infected with Omicron are more likely to become infectious earlier than previous strains of the virus so the risk of infecting others increases in the first 48 hours after exposure. 
  • Up to 50% of people infected with COVID may not show any symptoms.   
  • The potential for a household contact to develop infection of COVID-19 is significantly higher than someone who is a non-household contact. 
  • Age, those with two or more medical conditions (comorbidity) and medical vulnerability are contributing factors to negative outcomes of COVID infection. 
  • However those who have received the booster (three vaccinations) are less likely to require hospitalisation if they are infected with COVID.  

When a patient/service user facing health and social care worker has been identified as contact of a positive case

Before the worker attends the workplace the employer should ensure:

  • The staff member is asymptomatic.
  • The staff member agrees to use lateral flow tests before coming to work each day for 7 days.
  • If the staff member does not agree to test each day before coming to work, they should either be redeployed to a non-patient/service user facing role or instructed not to attend work for 7 full days from their last contact with the positive case.

When the employer has confirmed the points above they should consider:

Does the staff member work in close contact with colleagues or patients/service users who are known to be immunosuppressed and/or clinically extremely vulnerable?

If they do, it is advised that these members of staff should not ordinarily continue to work with these patients/service users. Consideration should be given to redeployment to work with patients/service users who are known to not be immunosuppressed and/or clinically extremely vulnerable for at least 7 days from the known contact with a positive case or a household contact’

Is the staff member a household contact?

If the staff member is a household contact employers are advised to request that, in addition to the use of LFTs for 7 days, the staff member take a PCR test on the first day someone in their household had COVID-19 symptoms or tests positive, or as soon as possible thereafter and receive the negative PCR result before they come into work. 

If a staff member has had a positive COVID-19 PCR test result within the previous 90 days, a local decision/risk assessment will be needed to determine the management of the staff member in terms of test monitoring or continuing to work.

Balancing non-COVID and potential COVID harms in healthcare 

If, on balance, a Health Board or Trust considers the absence of the member of staff may cause more non-COVID harms than potential direct COVID harms caused by potential infection, the Health Board /Trust could make a local decision to forgo the requirement of a PCR test and /or the wait for a negative result before the staff member can return to work (whilst still ensuring they continue to use LFTs before attending work each day for 7 days).

Within health boards and trusts, the medical and nursing leaders, the Board lead for Infection Prevention & Control (IPC) and/or Director of Public Health will be responsible for their own risk assessment and governance process for deviation from the information within this guidance.

In primary care the independent contractor should make decisions about this process in line with the criteria but must advise the health board about their approach.  

Employee responsibilities:

  • Should notify their employer as soon as they are aware they are a contact of someone who has tested positive or a household member is symptomatic or tested positive.
  • Explain the nature of their contact with the individual (household / non-household / unknown)
  • Should discuss and agree if
    • a PCR test and/or waiting for the result to be returned before attending work is required or
    • Temporary redeployment to non-patient/service user facing duties is required.
  • Should use lateral flow tests each day before coming to work for 7 days from known contact or positive result of a household member and not come into work if a positive result is identified.

Process governance

  • Within health boards and trusts, the medical and nursing leaders, the Board lead for IPC and/or Director of Public Health will work with each organisation on this risk assessment process and use of the checklist with staff.
  • In primary care the independent contractor should make decisions about this process in line with the criteria but must advise the health board about their approach.  
  • In regulated care services, the Responsible Individual is accountable for decision-making. Private sector employers may wish to liaise with health and social care commissioners.
  • Managers in supported housing will make decisions and liaise with local authority commissioners as appropriate.

Annex A - Fact sheet for patient/service user facing health and social care workers following identification as a COVID 19 contact

  • Staff member should inform manager as soon as a household member has symptoms or tests positive or when they have been identified as a contact via TTP or the COVID app. 
    • The staff member has a PCR test performed and has a negative result prior to returning to work. 
  • Following negative PCR result, Lateral Flow testing should commence on a daily basis up to day 7 from initial exposure, results should be reported on the on-line portal and manager informed. 
  • Consideration is given to the patients/service user with whom the worker has regular contact. Please consult the guidance for further information.

What staff can expect from their employer

  • That the employee checklist is completed in discussion with the staff member prior to staff member attending work. This should record PCR results, identifies that staff have no COVID-19 symptoms and records provision of LFD testing kits.
  • That staff are supported to record LFT results.
  • That consideration is given to the patients/service users the worker is usually in contact with.
  • That if appropriate, suitable redeployment is considered.

What employers should expect from staff

  • That they should have read this fact sheet to familiarise themselves with the policy and  agree to the testing regime.
  • That they participate in completion of the employer checklist and discussion with manager prior to attending work.
  • That they book a PCR test through agreed mechanisms and provide result to employer prior to returning to work.
  • That they agree to perform LFD tests, inform employer of and record results for 7 days from initial exposure to the person who has tested positive to COVID-19.
  • That they adhere to IPC procedures ensuring appropriate use of PPE at all times.
  • That they refrain from work, inform manager and book a PCR test if symptoms develop.

Annex B: Checklist for employer to complete with staff member

This assessment to be used if a relevant health or social care worker has been identified as a contact of a positive case of COVID 19. This should be completed before the worker returns to the workplace and so should be discussed via phone or video call.

Checklist: employer with employee
  Check Mitigation
1

Does the staff member have COVID-19 symptoms?
Symptoms:

  • A high temperature
  • A new, continuous cough
  • A loss, or change to sense of taste or smell

Yesshould attend for PCR and self-isolate

No move to Q 2
2 Does the employee work with patients/ service users known to be in either of the two groups outlined in the guidance?

No – Move to Q 3

Yes – these staff should ordinarily be redeployed to non-patient facing duties or to work with patients who are known not to be immunosuppressed or CEV for 7 full days 

3 Is anyone in the employees household tested positive, experiencing COVID symptoms or awaiting PCR results?

No – Move to Q 5
  
Yes – It is advised that the employee should book a PCR tests as soon as possible. Move to Q 4

4 Is their PCR status known? (household contacts only)

PCR negative -  Do they agree to test using LFTs every day for 7 days?  

Yes - move to Q.5 

PCR positive - Follow the self-isolation guidance staff. 

Status unknown – Need to book PCR in order to return to work

5 Does the staff member know where to access lateral flow devices and are able to use them appropriately?

Yes – take a LFD test each day before attending work for 7 days and receive a negative result before attending work and report result to their line manager and online Report a COVID-19 rapid lateral flow test result - GOV.UK (www.gov.uk).

No- Line manager should facilitate access to LFDs prior to return to work.– Staff member should test each day before work for 7 days as above.