Infection control during COVID-19

All COVID-19 restrictions and free mass testing have now ended.

NHS England has published revised national infection prevention and control guidance relating to both staff and patients. The accompanying letter from NHS England summarises the following protocols that should be in place for staff in the transition back to pre-pandemic measures:

• returning to pre-pandemic physical distancing in all areas
• returning to pre-pandemic cleaning protocols outside of COVID-19 areas.

The national infection prevention and control manual for England details how employers can support this transition through ensuring all staff:

• are aware of and have access to this guidance
• have had instruction/education on infection prevention and control by attending events and/or completing training
• have adequate support and resources to implement, monitor and take corrective action to comply with this guidance; if not, a risk assessment must be undertaken and approved through local governance procedures
• with health concerns (including pregnancy) or who have had an occupational exposure are referred promptly to the relevant agency, for example, GP, occupational health or emergency department
• have had the required health checks, immunisations, and clearance
• include infection prevention and control as an objective in their personal
• development plans
• refer to infection prevention and control in all job descriptions.

NHS England has published Living with COVID-19 white paper (23 February 2022), their Living with COVID-19 – testing (30 March 2022).  Additional guidance on managing healthcare staff with symptoms of a respiratory infection or a positive COVID-19 test result can be found on the GOV.UK website. Staff symptomatic and asymptomatic testing procedure details are outlined in NHS England's guidance.

Although people are no longer legally required to self-isolate, the government are still advising that NHS staff who test positive for COVID-19, who have received one or more doses of COVID-19 vaccine, who have any of the main symptoms of COVID-19, or have received a positive LFD, should still follow this government guidance. This is because it is still possible to get COVID-19 and spread it to others, even if you are fully vaccinated.

All providers should follow the new regular asymptomatic testing arrangements outlined by the DHSC. Regular asymptomatic testing was paused from Wednesday 31 August 2022 across all remaining settings including hospitals and care homes. Testing for individuals with symptoms in these settings, including health and social care staff, will continue.

For more information, read the government’s guidance on asymptomatic testing rules.

Staff members who test positive for COVID-19, or have symptoms of a respiratory infection should follow this guidance. Where a member of staff tests positive, organisations should consider the need to make a RIDDOR report, supported by this decision-making flow chart.

NHS England issued a letter providing an update on UK Health Security Agency guidance - confirmatory PCR tests to be temporarily suspended for positive lateral flow test results. This letter states that those who receive positive LFD results for COVID-19 will be required to self-isolate immediately and will not be required to take a confirmatory PCR test. This is because the vast majority of people with positive LFD results will have COVID-19 at current high prevalence rates.

Healthcare staff who have tested positive for COVID-19 should not attend work regardless of whether they have symptoms for five days. Patient-facing healthcare staff can return to work when they have had two consecutive negative LFD test results (taken at least 24 hours apart).

The first LFD test should only be taken five days after the day their symptoms started (or the day their first positive test was taken if they did not have symptoms); this is described as day zero.

If both LFD tests results are negative, they may return to work immediately after the second negative LFD test result, provided they meet the criteria outlined in the government guidance.

What to do if a test result is negative

If the LFD test result is negative, staff can attend work if they are clinically well enough to do so and they do not have a high temperature.

NHS England COVID-19 FAQs: Staff required to stay away from the workplace
These high-level FAQs hosted by NHS Employers have been developed by NHS England. The FAQs are informed by UK Health Security Agency guidance on managing respiratory infection or a positive COVID-19 test in the context of business as usual and cover when patient facing or non patient facing NHS staff test positive for COVID-19 and are required to stay away from their workplace.

Fully vaccinated staff who are identified as a contact of a positive COVID-19 case, will no longer have to isolate and will be expected to return to work. However, the following safeguards should be implemented to enable a safe return:

• Patient-facing healthcare staff who are identified as a close contact should continue with twice-weekly asymptomatic LFD testing.
• Staff who are identified as a household or overnight contact of someone who has had a positive COVID-19 test result should discuss ways to minimise risk of onwards transmission with their line manager.

Organisations may consider the following precautions:

• redeployment to lower risk areas for patient-facing healthcare staff, especially if the member of staff works with patients whose immune system means that they are at higher risk of serious illness despite vaccination
• working from home for non patient-facing healthcare staff
• limiting close contact with other people especially in crowded, enclosed or poorly ventilated spaces.

While they are attending work, staff must continue to comply rigorously with all relevant national infection prevention and control guidance.

If staff develop any symptoms during the ten days following contact with anyone who has COVID-19, they should follow the advice for staff with symptoms of a respiratory infection, including COVID-19

See guidance from NHS England for more information.

There are ongoing discussions and concerns surrounding legal restrictions on wearing facing coverings in public settings, such as health and social care settings. The National Infection Prevention and Control Manual England outlines the key principles of PPE use. 

NHS England has published a letter on next steps on infection prevention and control which outlines changes to face -mask wearing guidance in healthcare settings. It outlines requirements for both staff and patients, as well as visitation procedure recommendations. Whilst many settings will no longer implement social distancing rules, National Infection Prevention and Control Guidance will remain in place for all staff and visitors. 

The Department of Health and Social Care's free personal protective equipment (PPE) scheme.  

The purpose of the scheme is to support the government’s COVID-19 Response: Living with COVID-19 strategy during a challenging period of global inflation and cost of living pressures.  

The continued provision of free PPE for COVID-19 will:

• protect frontline healthcare staff, the elderly and vulnerable
• reduce pressure on the NHS.

The scheme has been extended until 31 March 2024 or until the Department of Health and Social Care’s (DHSC) stocks for COVID-19 supply are depleted (whichever is sooner). The DHSC encourage providers to only order PPE based on current demand.  Please note that DHSC will not accept returns of unused or expired PPE. Order limits will continue to apply and order volumes will be monitored.

DHSC will publish further information about stock-out dates by PPE category (when they expect to run out of specific types of PPE) by April 2023.

Heat stress and PPE

Heat stress can be a real risk threat to NHS staff that wear PPE in their role. It is important that employers need to know what to do to protect staff from heat stress in the workplace. 

Heat stress occurs when the body’s means of controlling its internal temperature starts to fail. Heat stress can affect individuals in different ways, and some people are more susceptible to it than others.  

HSE's guidance, Heat stress in the workplace, includes information about the risks to the body from overheating, gives practical guidance on how to avoid it and what you need to consider when carrying out risk assessments with your staff.

Update on supply of PPE

• Employers should ensure they have adequate supplies of PPE and keep up to date with the latest advice on the supply of PPE from NHS England.
• Eligible health and social care providers can order PPE through the online portal from the Department of Health and Social Care (DHSC).
• Organisations can report supply issues by contacting the 24/7 NHS Supply Disruption Line on 0800 915 9964 or supplydisruptionservice@nhsbsa.nhs.uk.

Advice on requiring staff to shave off facial hair and fitting PPE

NHS organisations are facing an emerging issue with PPE, specifically face masks. In order to be effective, FFP3 type face masks have to form a seal to the face. Face masks can often not be used correctly which is why fitting/fit testing is required to ensure they are being used effectively. Beards, stubble and facial hair cause a common problem when using PPE face masks, as this can prevent the mask being able to seal to the face and passing the fit test. Employers should talk with relevant staff and may want to engage with local faith groups when agreeing their approach to this issue. As COVID-19 continues, there is a significant increase in the numbers of staff who need to wear the mask, and those who need to be trained and ready to wear them.

There are alternatives to masks that can be provided where required, which are hoods or helmets. These are more expensive than face masks and would require a couple of hours’ training.

In the first instance, employers should explain their concerns to those staff required to use PPE and the risks associated with having facial hair and ask staff if they would be willing to be clean shaven to eliminate any risks. It may be helpful to include staff side in these conversations. Any concerns employees have should be discussed with their manager, getting further support from occupational health if required to fully understand any concerns and personal circumstances that may need to be taken into account. There are many reasons why an individual may not want to follow this request, which would need to be explored. Where required, alternative solutions should be explored to ensure staff are being supported as much as is reasonably possible. This might include other forms of PPE if available or working in areas of less risk.

Where a voluntary approach is not accepted, employers will need to consider the implications of requesting staff be clean shaven and whether this is proportionate. For example, it may be appropriate to redeploy clinical staff to non-clinical area. You may want to consider the following:

• the request could indirectly discriminate some employees by applying a provision, criterion or practice (PCP) that may disadvantage those of certain religions and/or faiths when compared to others
• an assessment should be made as to which areas this applies (for example, emergency departments and COVID-19 treatment centres) and the numbers of those potentially affected by the requirement to shave
• if the number is low, can alternative hooded/helmet PPE be provided and is the cost and training proportionate?
• is there a legitimate business need to insist that employees be clean shaven (prevention of the spread of virus/public health priorities) and is the requirement a proportionate means of achieving the aim? Where this is the case, a local approach should be agreed and implemented consistently, in line with risk assessments.

We understand that in some circumstances, encouraging the uptake of the vaccine can cause stress for some NHS staff members who are hesitant about receiving the vaccine. Holding regular health and wellbeing conversations can be a great place for staff to raise any concerns and hesitancy they may have in a safe space.

For employers to be able to do this effectively, we are sharing some of the initiatives that employers in the NHS have put in place to support vaccine hesitancy, such as:

• encouraging managers to have supportive conversations with staff to find out if they are or are not vaccinated
• making it easier for staff to get vaccinated by visiting wards and delivering vaccinations on site and doing call outs to let staff know vaccinations are still available
• arranged listening events with HR and occupational health for non-vaccinated staff to share how they are feeling and what their concerns are to try and ally any fears or misinformation
• sending out letters to all staff whose vaccination status was not known, to ask if they could let the team know their vaccination status
• re-opening vaccination hubs with bookable or drop-in slots, so staff are able to have their first, second, or a booster vaccination
• running weekly virtual drop-in sessions for staff not vaccinated to join and to raise any questions or concerns they have with clinical teams.

COVID-19 PPE guide for adult social care services and settings

This resource outlines PPE advice for health and social care workers working in the community.

Every action counts

Compliance with IPC measures is critical in healthcare settings as restrictions ease and more people are vaccinated. The Every Action Counts project was led by NHS England to better understand people’s behaviour to improve compliance with IPC. As a result, it has developed resources and a products suite to address the key themes of the research, and includes an implementation toolkit, COVID-19 monitoring checklists and hints and tips for IPC conversations. 

Infection prevention and control supporting documentation

Access guidance, training resources and links to campaign materials to support infection prevention and control measures across the NHS from the NHS England website. 

Ambulance service resources

Guidance specifically relating to ambulance services can be accessed through COVID-19 guidance for ambulance services.

Additional donning and doffing guidance is also available through the Joint Royal Colleges Ambulance Liaison Committee (JRCALC).