Article

Infection control during COVID-19

Guidance on the use of personal protective equipment and infection control procedures.

19 July 2021

Employees may well be concerned about the risk of infection due to COVID-19. 

Staff should not attend work if they have symptoms of COVID-19, or if they live with someone who has symptoms. Employers should ensure their staff are kept informed of the latest infection control guidance, adhere to hand washing, PPE protocols and ensure staff training is up to date. 

Employers should actively keep informed of the latest guidance and advice issued by the government, Public Health England and the Department of Health and Social Care alongside advice from local infection prevention and control specialists.

See the government’s website for 
guidance on COVID-19 infection prevention and control, which includes updates to strengthen existing messaging, providing updates on the hierarchy of controls, clarify over the use of valved respirators, and highlighting the need to protect those previously shielding/those considered to be clinically extremely vulnerable, and read the stay at home guidance for further information.

  • If a member of staff develops symptoms of COVID-19, they should: 

    • follow the stay at home guidance
    • while at home (off-duty), they should not attend work and notify their line manager immediately
    • while at work, they should put on a surgical face mask immediately, inform their line manager and return home
    • arrange to have a Polymerase Chain Reaction (PCR) test.

    NHS staff - COVID-19 testing

    NHS England and NHS Improvement has asked NHS trusts to ensure they are using the maximum testing capacity and, where possible, share this testing facility with neighbouring acute trusts, ambulance trusts, community, mental health, primary care and social services.

    If an employee develops symptoms of COVID-19, they should follow the government’s guidelines of getting a PCR test.

    All NHS staff are able to order lateral flow devices (LFD) testing kits from the government website. It is advised that LFD testing is carried out every three to four days to fit with shift patterns and leave requirements. You can read more the frequently asked questions about lateral flow antigen tests for asymptomatic staff testing as well as guidance on how to conduct and report a lateral flow test. Trusts may choose to implement an internal reporting system of home-testing results, too.

    Employers can access the resources, including posters and digital banners, to help promote the online booking service to staff from the Coronavirus Campaign Resource Centre.  More information on how to access testing through the online booking service and who is eligible can be found in the full guidance

  • Positive test results

    Staff members who test positive should follow government guidance to self-isolate. Where a member of staff tests positive, organisations should consider the need to make a RIDDOR report, supported by this decision-making flow chart and following the Health and Safety Executive (HSE) RIDDOR guidance.

    As the RIDDOR guidance was published prior to the pandemic, the Health and Safety Executive (HSE) has produced further guidance on RIDDOR reporting of COVID-19, which will help to determine if you need to make a report and provides some principles to use when assessing the information available and making your judgement. 

    Symptomatic staff who test positive, have an inconclusive test result, or have symptoms of COVID-19 but have not been tested should follow government guidance on exposure in healthcare settings and, can return to work:

    • no earlier than ten days from symptom onset, provided clinical improvement has occurred and they have been afebrile (not feverish) without medication for 48 hours and they are medically fit to return
    • if a cough or loss/change of smell (anosmia) or taste is the only persistent symptom after ten days (and they have been afebrile for 48 hours without medication), they can return to work if they are medically fit to return (these symptoms are known to persist for several weeks in some cases).

    Negative test results 

    Staff who test negative for COVID-19 can return to work when they are medically fit to do so, following discussion with their line manager and an appropriate local risk assessment. It is advised to interpret negative results with caution together with clinical assessment.

  • As of 16 August 2021, the government has changed the self-isolate requirements following a positive COVID-19 contact. This supersedes previous Public Health England (PHE) guidance.

    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. The following safeguards should be implemented to enable a safe return:

    • a negative PCR test prior to returning to their NHS workplace. Employees should not attend work while awaiting the PCR test result
    • the staff member must have had two doses of an approved vaccine, at least 14 days post double vaccination at the point of exposure
    • provision of subsequent, daily negative LFD antigen tests for a minimum of 10 days before commencing a shift (with test results reported to Test and Trace via the web portal and to their duty manager or an identified senior staff member). Any contact who has a positive LFD test should self-isolate and arrange a PCR test
    • the staff member is and remains asymptomatic
    • continued use of IPC measures, in line with the current UK IPC guidance.

    Please note: If the staff member is living directly (same household) with a positive COVID-19 case, they will be asked not to come to work. This will remain under review. There may be times when it is appropriate for the staff living with a positive COVID-19 case to return to work, in line with government guidance, in a risk-assessed way, but this should be through a process agreed with an appropriate senior decision maker (for example DPH/DIPC). All staff and students must have an up to date individual risk assessment and be working in an appropriate setting for their risk status.

    Read the updated Public Health England guidance letter for full details including information about local workplace risk assessments and ways in which to support and protect our colleagues, patients and services.  We are aware that the information detailed in this guidance letter may not be fully reflected on the gov.uk website, however, we reiterate that the guidance in the letter supersedes previous PHE guidance.

  • There are ongoing discussions and concerns surrounding legal restrictions on wearing facing coverings in public settings, such as health and social care settings. The British Medical Association (BMA) have suggested certain measures and support should remain in place, which you may find useful to read.

    On 15 July 2021, Chief Nursing Officer for England, Ruth May reminded the public that anyone accessing or visiting healthcare settings must continue to wear a face covering and follow social distancing rules. Whilst many settings will no longer implement social distancing rules, Public Health England’s infection prevention guidelines and hospital guidance will remain in place for all staff and visitors. You can read more about this on NHS England’s news page. 

    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 and NHS Improvement.

    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.

    These are exceptional circumstances as the UK continues to contain the virus and employers do their best to protect the health, safety and wellbeing of staff and patients. 

  • Every action counts

    Compliance with infection prevention control (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 and Improvement (NHSEI) to better understand peoples’ behaviour to improve compliance with IPC. As a result, they have 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. 

    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).  

    Every action counts

    Compliance with infection prevention control (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 and Improvement to better understand peoples’ behaviour to improve compliance with IPC. As a result, they have 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. 

    Mental wellbeing

    It is normal for employees to feel anxious or worried about the uncertainty of the COVID-19 outbreak, with its fluctuating infection rates. We have some web pages to help line managers support workplace mental wellbeing: