Article

Infection control during COVID-19

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

13 June 2022

Employers should ensure their staff are kept informed of the latest COVID-19: information and advice for health and care professionals guidance. They should adhere to hand washing, personal protective equipment (PPE) protocols, ensure staff training is up to date and symptomatic NHS staff should test themselves using lateral flow devises (LFD).

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

It is particularly important for NHS provider organisations to follow infection prevention control (IPC) guidance during the winter months. Updated NHS national infection prevention and control manual from the UK Health Security Agency (UKHSA) makes recommendations to help prevent transmission of seasonal respiratory viral infections, including flu, COVID-19, and respiratory syncytial virus (RSV) in health and care settings, while continuing to support the recovery of services. There is a separate piece of infection prevention and control guidance for the ambulance service. In addition, the NHS England and NHS Improvement published a letter on next steps on infection prevention and control which outlines new guidance on face mask wearing procedures and visitation rules.

The IPC principles described apply to all UK health and care settings, including the independent or private sector, and care at home. Please refer to the updated guidance rather than earlier versions which may be saved locally.

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

    The UK Health Security Agency (UKHSA) has published revised national infection prevention and control guidance relating to both staff and patients. The accompanying letter from NHS England and NHS Improvement (NHSEI) 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 accident and emergency
    • 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 and NHS Improvement has published Living with COVID-19 white paper (23 February 2022), their Living with COVID-19 – testing (30 March 2022) and 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 lateral flow device (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 COVID-19 testing arrangements issued by NHS England. 

    Patient-facing healthcare staff should continue to test twice a week for COVID-19 using LFD tests. Test results should be reported on the GOV.UK portal.

    If they receive a positive LFD test result, they should follow the advice in the section for staff members who receive a positive LFD test result for COVID-19 .

    Follow NHS England's guidance for more information.

  • 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 and NHS Improvement has 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 lateral flow device (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.

  • 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:

    Whilst 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 these 10 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 and NHS Improvement 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. The British Medical Association (BMA) also  suggests certain measures and support should remain in place, which you may find useful to read.

    NHS England and Improvement have 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. 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.

    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.

    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. 

  • 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 NHS employers 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.
  • 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 NHS 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. 
     

    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 and NHS Improvement 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).